Healthcare Provider Details

I. General information

NPI: 1275861999
Provider Name (Legal Business Name): KEVIN WAYNE WOJAHN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 BROADWAY AVE N
BRAHAM MN
55006-4711
US

IV. Provider business mailing address

521 BROADWAY AVE N
BRAHAM MN
55006-4711
US

V. Phone/Fax

Practice location:
  • Phone: 320-396-3333
  • Fax: 320-396-3363
Mailing address:
  • Phone: 320-396-3333
  • Fax: 320-396-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2058
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: