Individual
MIRANDA MARIE FASSBENDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
230 DERONDA ST, AMERY, WI 54001-1412
(715) 268-8000
Mailing address
2265 COMO AVE, SAINT PAUL, MN 55108-1737
(651) 645-5323
(651) 379-6141
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1887
MN
101YP2500X
Professional Counselor
Primary
5640.125
WI
Other
Enumeration date
02/27/2013
Last updated
02/11/2019
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