Healthcare Provider Details

I. General information

NPI: 1902353352
Provider Name (Legal Business Name): LAURA MARIE WENDEL MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA MARIE HAUGO MS, CGC

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 LOUISIANA AVE S STE E111
SAINT LOUIS PARK MN
55426-5000
US

IV. Provider business mailing address

8365 TILIA LN
VICTORIA MN
55386-8231
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-7489
  • Fax:
Mailing address:
  • Phone: 320-221-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: