JAY PHILIP WISTROM

SAINT CLOUD, MN
NPI1144587452
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: MN  303309)
Enumeration Date2012-04-12
Last Update Date2012-04-12
Business Address
-- JAY PHILIP WISTROM LADC
1321 13TH ST N
SAINT CLOUD, MN 56303-2613
Phone number: 320-252-5010
Mailing Address
-- JAY PHILIP WISTROM LADC
1321 13TH ST N
SAINT CLOUD, MN 56303-2613
Phone number: 320-252-5010
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