Individual
MS. LISA MARIE WICKLUND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
9140 BALTIMORE ST NE STE 140-5, BLAINE, MN 55449-4382
(612) 481-9718
Mailing address
9140 BALTIMORE ST NE STE 140-5, BLAINE, MN 55449-4382
(612) 481-9718
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17-07455
MN
Other
Enumeration date
05/24/2017
Last updated
07/21/2022
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