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General NPI Number Information
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NPI Number | 1225355977
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Entity Type | Individual
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Provider Name | KARA LYN WONG M.A. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 03/15/2013
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Provider Practice Location Address
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Address Line | 10201 WAYZATA BLVD SUITE 220
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City | MINNETONKA
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State | MN
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Zip | 55305-5507
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Country | US
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Telephone | 612-599-3342
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Fax |
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Provider Business Mailing Address
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Address Line | 10600 THOMAS AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55431-3722
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Country | US
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Telephone | 612-599-3342
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8334
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License Number State | MN
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