| Doctor Name: | DR. GINA MACKENZIE WOLFGRAM |
| NPI Number: | 1376985077 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AU.D. |
| License Number: | 8886 |
| Business Practice Address: | 1835 County Road C W Suite 80 Roseville, MN - 551131352 |
| Business Phone Number: | 6516389981 |
| Business Fax Number: | |
| Mailing Address: | 2848 2nd St S, Suite 145 SAINT CLOUD |
| State: | MN |
| Postal Code: | 563014594 |
| Phone Number: | 3202520094 |
| Fax Number: | |
| NPI Enumeration Date: | 07/23/2013 |
| NPI Last Update Date: | 07/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 237600000X |
| License Number: | 8886 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Audiologist-Hearing Aid Fitter |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An audiologist/hearing aid fitter is the professional who specializes in evaluating and treating people with hearing loss, conducts a wide variety of tests to determine the exact nature of an individual |