Individual
JESSICA CHRISTINE WAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
3483 FAIR OAKS CT, WHITE BEAR LAKE, MN 55110-4578
(651) 815-3752
Mailing address
3483 FAIR OAKS CT, WHITE BEAR LAKE, MN 55110-4578
(651) 815-3752
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10142
MN
Other
Enumeration date
08/06/2019
Last updated
08/06/2019
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