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Individual

BREANNA LOUISE WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4140 RICHARD AVE STE 200, HERMANTOWN, MN 55811-3309
(218) 514-5230
Mailing address
618 CUMMING AVE, SUPERIOR, WI 54880-1150
(715) 817-1169

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
MN

Other

Enumeration date
11/02/2021
Last updated
11/02/2021
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