Individual
SUSAN WAIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 SUGAR LOAF RD APT 2, WINONA, MN 55987-5552
(507) 458-8567
Mailing address
1100 SUGAR LOAF RD APT 2, WINONA, MN 55987-5552
(507) 458-8567
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
1074219-1-HCBS
MN
Other
Enumeration date
08/15/2014
Last updated
08/15/2014
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