Individual
DR. ANASTASIA SULLWOLD RISTAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD LP
Contact information
Practice address
111 HUNDERTMARK RD STE 205N, CHASKA, MN 55318-1586
(952) 903-1350
(952) 426-3856
Mailing address
9400 ZANE AVE N, BROOKLYN PARK, MN 55443-1814
(763) 762-8800
(763) 315-4669
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4538
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
949674200
—
MN
Enumeration date
07/21/2006
Last updated
11/10/2020
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