Provider Demographics
NPI:1235483702
Name:WIENS, KATHERINE ALYSSA (MS, CGC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALYSSA
Last Name:WIENS
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 CHURCH ST SE
Mailing Address - Street 2:6-160 JACKSON HALL
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0250
Mailing Address - Country:US
Mailing Address - Phone:612-624-0931
Mailing Address - Fax:
Practice Address - Street 1:321 CHURCH ST SE
Practice Address - Street 2:6-160 JACKSON HALL
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0250
Practice Address - Country:US
Practice Address - Phone:612-624-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS