Individual
DONNA WAHLSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
105 6TH AVE S, PRINCETON, MN 55371-1819
(763) 308-0006
Mailing address
1264 HARBOR ST, OGILVIE, MN 56358-3621
(320) 272-4897
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303084
MN
Other
Enumeration date
10/24/2014
Last updated
10/24/2014
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