Provider Demographics
NPI:1376985077
Name:WOLFGRAM, GINA MACKENZIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MACKENZIE
Last Name:WOLFGRAM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 BLAINE AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1239
Mailing Address - Country:US
Mailing Address - Phone:651-888-7800
Mailing Address - Fax:651-888-7801
Practice Address - Street 1:5565 BLAINE AVE STE 225
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1239
Practice Address - Country:US
Practice Address - Phone:651-888-7803
Practice Address - Fax:651-888-7803
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8886237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter