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Individual

DARLENE FAYE WETTERSTROM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LICSW

Contact information

Practice address
6701 PENN AVE S STE 301, RICHFIELD, MN 55423-2085
(651) 337-1454
Mailing address
6701 PENN AVE S STE 301, RICHFIELD, MN 55423-2085
(651) 337-1454

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10482
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
800000455
MEDICARE
MN
05
8660140-00
MN
Enumeration date
10/23/2009
Last updated
10/23/2009
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