MEDICARE: LAURA MARIE WENDEL MS, CGC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1902353352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIE WENDEL MS, CGC

Provider Business Mailing Address
First Line	:	8365 TILIA LN
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-8231
Country	:	US
Telephone Number	:	320-221-3537
Fax Number	:

Provider Business Practice Location Address
First Line	:	3931 LOUISIANA AVE S STE E111
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55426-5000
Country	:	US
Telephone Number	:	952-993-7489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	07/03/2024

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