Individual
TRACEY WAHLQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11100 86TH AVE N, MAPLE GROVE, MN 55369
(763) 755-4275
Mailing address
1891 STATION PARKWAY NW, ANDOVER, MN 55304-4259
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10005
MN
Other
Enumeration date
11/20/2017
Last updated
11/20/2017
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