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Individual

DR. MERYL G WILLERT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
300 45TH ST SW, SUITE 311, FARGO, ND 58103-1189
(701) 837-6508
(701) 858-1839
Mailing address
PO BOX 1148, MINOT, ND 58702-1148
(701) 837-6508
(701) 858-1839

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
287
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
18694
ND
01
20281773958103A002
TRICARE
ND
01
28552
BCBS - MINOT
01
28565
BCBS - FARGO
ND
01
58569
BCBS - BISMARCK
ND
01
61-28263
MEDICA (UBH)
Enumeration date
01/23/2006
Last updated
08/21/2007
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