LYLE WALTER WAGNER

COON RAPIDS, MN
NPI1649683939
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy103TC0700X Psychologist, Clinical
(Licence: MN  5751)
Enumeration Date2014-06-04
Last Update Date2014-06-04
Business Address
-- LYLE WALTER WAGNER PhD, LP
3907 COON RAPIDS BLVD NW
COON RAPIDS, MN 55433-2520
Phone number: 320-629-7600
Mailing Address
-- LYLE WALTER WAGNER PhD, LP
220 RAILROAD ST SE
PINE CITY, MN 55063-1540
Phone number: 320-629-7600