Provider Demographics
NPI:1639516370
Name:WEDIN, BREANN (MS, SLP)
Entity Type:Individual
Prefix:MRS
First Name:BREANN
Middle Name:
Last Name:WEDIN
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 MAIN ST NW
Mailing Address - Street 2:APT 206
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1743
Mailing Address - Country:US
Mailing Address - Phone:320-224-4248
Mailing Address - Fax:
Practice Address - Street 1:1107 HART BLVD STE 10
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8539
Practice Address - Country:US
Practice Address - Phone:763-295-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist