Healthcare Provider Details

I. General information

NPI: 1992946958
Provider Name (Legal Business Name): WENDY JEAN FORBREGD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 7TH AVE S
SAINT CLOUD MN
56301-5711
US

IV. Provider business mailing address

PO BOX 2390
SAINT CLOUD MN
56302-2390
US

V. Phone/Fax

Practice location:
  • Phone: 320-650-1556
  • Fax: 320-650-1599
Mailing address:
  • Phone: 320-650-1544
  • Fax: 320-650-1528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1524
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: