Individual
ELAINE R. WYNNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
315 GEORGIA AVE N, GOLDEN VALLEY, MN 55427-4978
(763) 546-1662
Mailing address
PO BOX 27314, GOLDEN VALLEY, MN 55427-0314
(763) 546-1662
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1876
MN
Other
Enumeration date
12/13/2006
Last updated
07/08/2007
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