Individual
KASEY LYNN WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8805 QUINCY ST NE, BLAINE, MN 55434-2351
(612) 231-3330
Mailing address
8805 QUINCY ST NE, BLAINE, MN 55434-2351
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9446
SPEECH LANGUAGE PATHOLOGIST DEPARTMENT OF HEALTH LICENSE
MN
Enumeration date
10/27/2015
Last updated
10/27/2015
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