Individual
TIMOTHY DEL WIERTZEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A., LMFT
Contact information
Practice address
8669 EAGLE POINT BLVD, LAKE ELMO, MN 55042-8628
(651) 379-0444
(651) 379-0448
Mailing address
8669 EAGLE POINT BLVD, LAKE ELMO, MN 55042-8628
(651) 379-0444
(651) 379-0448
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2142
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164722005
—
MN
Enumeration date
10/26/2010
Last updated
12/23/2011
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