Organization
MEMORY DISORDERS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SANDRA WENNER (EXECUTIVE DIRECTOR)
(320) 203-2000
Entity
Organization
Contact information
Practice address
1245 15TH ST N, SAINT CLOUD, MN 56303-1802
(320) 203-2093
Mailing address
10915 264TH ST, SAINT CLOUD, MN 56301-9411
(320) 293-2128
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
100395
MN
Other
Enumeration date
05/17/2007
Last updated
08/22/2020
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