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Individual

MS. BRIDGET KAY WICKSTROM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1720 124TH AVE NW, COON RAPIDS, MN 55448-1955
(651) 338-9104
Mailing address
1720 124TH AVE NW, COON RAPIDS, MN 55448-1955
(651) 338-9104

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary

Other

Enumeration date
04/15/2013
Last updated
04/15/2013
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