Individual
PAUL M WENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD LP
Contact information
Practice address
1555 NORTHWAY DRIVE, SUITE 200, ST CLOUD, MN 56303-4913
(320) 240-3157
(320) 240-3143
Mailing address
1555 NORTHWAY DRIVE, SUITE 200, ST CLOUD, MN 56303-4913
(320) 240-3157
(320) 240-3143
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2604
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
334724900
—
MN
Enumeration date
05/10/2006
Last updated
06/14/2013
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