Organization
THE COMPASSION BOUTIQUE PC
Active
Organization
THE COMPASSION BOUTIQUE PC
Active
Other names
The Compassion Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIZABETH WAGNER PSYD (CEO)
(952) 295-9099
Entity
Organization
Contact information
Practice address
4500 PARK GLEN RD STE 450, ST LOUIS PARK, MN 55416-5190
(952) 259-9099
Mailing address
4500 PARK GLEN RD STE 450, ST LOUIS PARK, MN 55416-5190
(952) 259-9099
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
11/09/2024
Last updated
11/09/2024
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