PHOENIX LYN BLACK WALKER (NPI# 1245755107) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245755107 |
| Entity Type | Individual |
| Full Name | PHOENIX LYN BLACK WALKER |
| Other Name | CHERYL LYNN MULLIS-DWORNIKOWSK |
| Credential | LADC |
| Practice Address |
1401 E 1st St Duluth MN 55805-2407 |
| Practice Telephone | 2187284491 |
| Practice Fax Number | 2187302367 |
| Mailing Telephone | 2187284491 |
| Mailing Fax Number | 2187302367 |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2017-08-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
300519 | MN | Behavioral Health & Social Service Providers |
| Street Address |
1401 E 1ST ST |
| City | DULUTH |
| State | MN |
| Zip Code | 55805-2407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194790733 | Human Development Center | Counselor | 1401 E 1st St, Duluth, MN 55805-2407 | 2006-02-17 |
| 1861945743 | Brent Hanson | Registered Nurse | 1401 E 1st St, Duluth, MN 55805-2407 | 2016-07-27 |
| 1700239571 | Deborah Hernandez | Community Health Worker | 1401 E 1st St, Duluth, MN 55805-2407 | 2016-07-18 |
| 1801246061 | Rachel Leigh Phillips | Counselor | 1401 E 1st St, Duluth, MN 55805 | 2016-06-20 |
| 1902261654 | Molly Smith | Social Worker | 1401 E 1st St, Duluth, MN 55805-2407 | 2015-12-23 |
| 1255716817 | Allison Hill | Nurse Practitioner | 1401 E 1st St, Duluth, MN 55805-2407 | 2015-07-24 |
| 1821339177 | Angela Tonee Marino | Social Worker | 1401 E 1st St, Duluth, MN 55805-2407 | 2013-03-12 |
| 1205195294 | Timothy R Walters | Counselor | 1401 E 1st St, Duluth, MN 55805-2407 | 2012-05-10 |
| 1255698205 | Scott Kenneth Johnson | Social Worker | 1401 E 1st St, Duluth, MN 55805-2407 | 2012-04-16 |
| 1003182643 | Jill Lockwood | Registered Nurse | 1401 E 1st St, Duluth, MN 55805-2407 | 2012-03-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356852180 | Peace of Mind of Duluth, Inc. | Community/Behavioral Health | 1000 East 1st Street, Suite 100, Duluth, MN 55805 | 2017-10-19 |
| 1891213419 | Arielle Skalisky | Registered Nurse | 400 E. 3rd Street, Duluth, MN 55805 | 2017-09-04 |
| 1457886400 | Chefrdn, LLC | Dietitian, Registered | 1101 East 4th Street, Duluth, MN 55805 | 2017-04-27 |
| 1962811604 | Claire Elena Kap | Nurse Practitioner | Essentia Health Duluth Clnic, 400 East Third Street, Duluth, MN 55805 | 2014-08-06 |
| 1598196313 | Kelsey Lindsay Putvin | Audiologist | 400 E 3rd St., Duluth, MN 55805 | 2013-12-04 |
| 1639462997 | James F Conniff | Family Medicine | Duluth Family Medicine Clinic, 330 N Eighth Ave E, Duluth, MN 55805 | 2011-05-19 |
| 1215237433 | Bobby Jo Mineheine | Speech-Language Pathologist | 530 East Second St, Polinsky Medical Rehab Ctr, Duluth, MN 55805 | 2010-10-22 |
| 1891004248 | Robin Michelle Warfel | Occupational Therapist | 530 East 2nd Street, Polinsky Medical Rehabilitation Center, Duluth, MN 55805 | 2010-10-04 |
| 1154638716 | Jennifer Chen | Pharmacist | 420 E 1st St Mail Drop 1s3w10, Duluth, MN 55805 | 2010-09-02 |
| 1376858084 | Jennifer Lynn Howard | Pharmacist | 211 West Fourth Street, Center for American Indian Resources, Duluth, MN 55805 | 2010-08-18 |
| Find all providers in zip 55805 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649879339 | Jordan Lowe | Counselor | 4615 Grand Ave Ste 300, Duluth, MN 55807-2749 | 2020-10-22 |
| 1750998423 | Recovery Alliance Duluth | Counselor | 206 W 4th St Ste 203, Duluth, MN 55806-2659 | 2020-09-28 |
| 1780239442 | Katelyn Huberty | Counselor | 324 W Superior St Bldg Suite620, Duluth, MN 55802-1701 | 2019-08-08 |
| 1831663343 | Jennifer T Rennquist | Counselor | 5223 Glendale St, Duluth, MN 55804-1110 | 2019-01-17 |
| 1376069294 | Dave Moorthy | Counselor | 6290 Abbotts Bridge Rd Ste 502, Duluth, GA 30097-5714 | 2017-08-22 |
| 1982151361 | Tiffany Riester | Counselor | 332 W Superior Street, Suite 300, Duluth, MN 55802 | 2016-09-02 |
| 1285063115 | Brian Bergstedt | Counselor | 332 West Superior Street, Suite 300, Duluth, MN 55802 | 2013-11-01 |
| 1558660357 | Melissa June Huray | Counselor | 326 North Central Avenue, Duluth, MN 55807 | 2011-03-18 |
| 1184760738 | Diana Benjamin Rodriguez | Counselor | 6340 Sugarloaf Parkway, Suite 200, Duluth, GA 30097 | 2007-01-30 |
| 1194790733 | Human Development Center | Counselor | 1401 E 1st St, Duluth, MN 55805-2407 | 2006-02-17 |
| Find all providers in DULUTH | ||||
Please comment or provide details below to improve the information on PHOENIX LYN BLACK WALKER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.