Provider Demographics
NPI:1679739635
Name:GREENWALDT, CHERYL LYNN (MA, LPCC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:GREENWALDT
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 2ND ST SW STE 1
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1483
Mailing Address - Country:US
Mailing Address - Phone:218-631-1714
Mailing Address - Fax:218-631-4228
Practice Address - Street 1:11 2ND ST SW STE 1
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1483
Practice Address - Country:US
Practice Address - Phone:218-631-1714
Practice Address - Fax:218-631-4228
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPC00093101YM0800X
MNLPCC76101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health