Individual
MRS. ANNE L WYSOCKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
2400 47TH AVE S, GRAND FORKS, ND 58201-3405
(701) 746-2300
Mailing address
2400 47TH AVE S, GRAND FORKS, ND 58201-3405
(701) 746-2300
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
788
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52149
—
ND
Enumeration date
01/25/2007
Last updated
07/08/2007
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