Individual
ALLISON WAHLBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10450 185TH ST W STE 100, LAKEVILLE, MN 55044-6696
(612) 509-6690
Mailing address
10450 185TH ST W STE 100, LAKEVILLE, MN 55044-6696
(507) 322-7752
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588993091
—
MN
Enumeration date
09/18/2020
Last updated
09/18/2020
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