Individual
KATHLEEN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1935 COUNTY ROAD B2 W STE 100, ROSEVILLE, MN 55113-2722
(651) 636-4155
Mailing address
114 118TH AVE NE, BLAINE, MN 55434-1929
(320) 491-6534
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9873
MN
Other
Enumeration date
05/25/2017
Last updated
05/25/2017
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