MS. Lisa Marie Wicklund, LMT

NPI #1609304476 in Blaine, Minnesota

Provider Information

NPI Number: 1609304476
Entity Type: Individual
Name: MS. Lisa Marie Wicklund, LMT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Credential: LMT
Enumeration Date: May 24, 2017
Last Updated: Jul 21, 2022

Practice Location

Address: 9140 BALTIMORE ST NE STE 140-5
City: Blaine
State: Minnesota
ZIP Code: 55449-4382
Phone: (612) 481-9718

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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