Jay Philip Wistrom, LADC
NPI #1144587452 in Saint Cloud, Minnesota
Provider Information
- NPI Number
- 1144587452
- Entity Type
- Individual
- Name
- Jay Philip Wistrom, LADC
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Counselor - Addiction (Substance Use Disorder)
- Credential
- LADC
- Enumeration Date
- Apr 12, 2012
- Last Updated
- Apr 12, 2012
Practice Location
- Address
- 1321 13TH ST N
- City
- Saint Cloud
- State
- Minnesota
- ZIP Code
- 56303-2613
- Phone
- (320) 252-5010
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder) |
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