Individual
BRYDON THOMAS WANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1505 30TH AVE S, MOORHEAD, MN 56560-5149
(218) 287-4338
Mailing address
1547 30TH AVE S, MOORHEAD, MN 56560-5149
(218) 287-4338
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
—
—
174400000X
Specialist
Primary
—
—
225C00000X
Rehabilitation Counselor
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/10/2022
Last updated
09/12/2024
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