Individual
ALEXANDRA LEIGH WAGENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
5105 WOODLAWN BLVD, MINNEAPOLIS, MN 55417-1349
(612) 710-1872
Mailing address
5105 WOODLAWN BLVD, MINNEAPOLIS, MN 55417-1349
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
T-LMLP 1332
KS
Other
Enumeration date
08/09/2010
Last updated
07/18/2012
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