Bockting, Walter O

Bockting, Walter O is an individual health care provider with primary practice located at 1300 S 2Nd St Suite 180, Minneapolis MN 55454-1075. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Bockting, Walter O can be contacted via phone (612) 625-1500.

Contact Information

Primary practice address
1300 S 2Nd St Suite 180 Minneapolis MN 55454-1075
Phone: (612) 625-1500
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X LP2505 Minnesota
Behavioral Health & Social Service Providers / Clinical 103TC0700X LP2505 Minnesota
Behavioral Health & Social Service Providers / Clinical 103TC0700X 020658 New York

Profile Details

NPI number 1104901172
LBN Legal business name Bockting, Walter O
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 26th, 2006
Last updated Mar 19th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104901172 NPPES
Minnesota MEDICAID 048313300
Minnesota Other 1007664
Minnesota Other 602T9BO
Minnesota Other 61-81256
Minnesota Other 102450
Minnesota Other HP50070

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