Individual
KATHERINE WIDESTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6025 109TH AVE N, CHAMPLIN, MN 55316-3475
(763) 506-7754
Mailing address
6025 109TH AVE N, CHAMPLIN, MN 55316-3475
(763) 506-7754
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7196
MN
Other
Enumeration date
08/04/2005
Last updated
05/07/2026
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