MEDICARE: WANDA VUE

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	306588	MN

General Provider Information

NPI Number	:	1740091255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA VUE

Provider Business Mailing Address
First Line	:	7831 GLENROY RD
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55439
Country	:	US
Telephone Number	:	651-447-3755
Fax Number	:

Provider Business Practice Location Address
First Line	:	7831 GLENROY RD
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55439-3132
Country	:	US
Telephone Number	:	651-447-3755
Fax Number	:

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

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	01/15/2025

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Directions to “ WANDA VUE ” Practice Location

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