Provider Demographics
NPI:1710309257
Name:WOLF-FALCON, GINA MARIE (CMT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:WOLF-FALCON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 10TH AVE NE
Mailing Address - Street 2:APT #122
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-4646
Mailing Address - Country:US
Mailing Address - Phone:320-260-6672
Mailing Address - Fax:
Practice Address - Street 1:401 DEWEY ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-8406
Practice Address - Country:US
Practice Address - Phone:320-968-7413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist