Provider Demographics
NPI:1639831837
Name:WOLTERS, BRIANNE
Entity Type:Individual
Prefix:MS
First Name:BRIANNE
Middle Name:
Last Name:WOLTERS
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 1:114 MAIN ST N STE 210B
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-1819
Mailing Address - Country:US
Mailing Address - Phone:651-661-6550
Mailing Address - Fax:320-753-0779
Practice Address - Street 1:114 MAIN ST N STE 201B
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-1819
Practice Address - Country:US
Practice Address - Phone:612-554-1532
Practice Address - Fax:320-753-0779
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health