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1083120984
BREANNA WAGNER
EDEN PRAIRIE, MN
NPI
1083120984
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2017-12-14
Last Update Date
2017-12-14
Business Address
BREANNA WAGNER
11010 PRAIRIE LAKES DR STE 350
EDEN PRAIRIE, MN 55344-3801
Phone number: 952-746-2522
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Mailing Address
BREANNA WAGNER
1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON, MN 55112-1789
Phone number:
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