Wistrom, Jay Philip

Wistrom, Jay Philip is an individual health care provider with primary practice located at 1321 13Th St N , Saint Cloud MN 56303-2613. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Wistrom, Jay Philip can be contacted via phone (320) 252-5010.

Contact Information

Primary practice address
1321 13Th St N Saint Cloud MN 56303-2613
Phone: (320) 252-5010
Fax: (320) 203-1855
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 303309 Minnesota

Profile Details

NPI number 1144587452
LBN Legal business name Wistrom, Jay Philip
Credentials LADC
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 12th, 2012
Last updated Apr 12th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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