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1649683939
LYLE WALTER WAGNER
COON RAPIDS, MN
NPI
1649683939
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
103TC0700X Psychologist, Clinical
(Licence: MN 5751)
Enumeration Date
2014-06-04
Last Update Date
2014-06-04
Business Address
-- LYLE WALTER WAGNER PhD, LP
3907 COON RAPIDS BLVD NW
COON RAPIDS, MN 55433-2520
Phone number: 320-629-7600
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Mailing Address
-- LYLE WALTER WAGNER PhD, LP
220 RAILROAD ST SE
PINE CITY, MN 55063-1540
Phone number: 320-629-7600
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