Individual
KATHLEEN MARIE WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., L.P.
Contact information
Practice address
7600 BASS LAKE RD, SUITE 106, NEW HOPE, MN 55428-3860
(612) 865-9143
Mailing address
205 LILY POND CIR, LORETTO, MN 55357-9654
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3227
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500526400
—
MN
Enumeration date
10/12/2005
Last updated
07/16/2010
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