Provider Demographics
NPI:1336495902
Name:DIGRE, WENDY RAE
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:RAE
Last Name:DIGRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 W ADOLPHUS AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-3405
Mailing Address - Country:US
Mailing Address - Phone:218-770-4958
Mailing Address - Fax:
Practice Address - Street 1:228 W ADOLPHUS AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-3405
Practice Address - Country:US
Practice Address - Phone:218-770-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1063786-1-AFC253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency