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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