Individual
KATYANA MARIE WIEDENMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1220 MAIN AVE, SUITE 120, FARGO, ND 58103-8201
(701) 364-5433
(701) 364-2256
Mailing address
1220 MAIN AVE, SUITE 120, FARGO, ND 58103-8201
(701) 364-5433
(701) 364-2256
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1119
ND
Other
Enumeration date
08/31/2010
Last updated
10/20/2014
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