Individual
KRISLEA ERIN WEGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1606 C 30TH AVE S, MOORHEAD, MN 56560
(218) 287-4338
(218) 287-5928
Mailing address
1606 C 30TH AVE S, MOORHEAD, MN 56560
(218) 287-4338
(218) 287-5928
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
383
ND
103TC0700X
Clinical Psychologist
Primary
4648
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13681
—
ND
01
—
26579
BLUE CROSS
ND
Enumeration date
10/03/2006
Last updated
07/08/2007
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