Individual provider · Type 1 NPI
Jay Philip Wistrom, LADC
Addiction (Substance Use Disorder) Counselor · St. Cloud, MN
NPI number
1144587452
Active
Practice location
1321 13th St N
St. Cloud, MN 56303-2613
Fax (320) 203-1855
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 303309 (MN) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
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About NPI 1144587452
Jay Philip Wistrom, LADC's National Provider Identifier is 1144587452, issued on Apr 12, 2012. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in St. Cloud, MN. The record was last updated on Apr 12, 2012.