Provider Demographics
NPI:1609108612
Name:TALAN, LOURDES M (LICSW)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:M
Last Name:TALAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 E RIVER PARKWAY
Mailing Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414
Mailing Address - Country:US
Mailing Address - Phone:612-596-6100
Mailing Address - Fax:612-339-5954
Practice Address - Street 1:2025 E RIVER PARKWAY
Practice Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414
Practice Address - Country:US
Practice Address - Phone:612-596-6100
Practice Address - Fax:612-339-5954
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15729104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker