Individual
LIBBY FAITH MEDENWALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4342 15TH AVE S STE 105, FARGO, ND 58103-1125
(701) 936-9495
Mailing address
1530 1ST AVE N STE 150, MOORHEAD, MN 56560-0002
(228) 218-3296
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
MN
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/08/2023
Last updated
02/17/2025
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