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Individual

CRISTOFER WALLBERG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
10450 185TH ST W STE 100, LAKEVILLE, MN 55044-6696
(612) 509-1283
Mailing address
10450 185TH ST W STE 100, LAKEVILLE, MN 55044-6696
(952) 923-8607

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
247200000X
Other Technician

Other

Enumeration date
04/06/2021
Last updated
04/22/2022
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