Individual
JESSICA ROSE VANDER WEYST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
1406 6TH AVENUE NORTH, ST. CLOUD HOSPITAL, ST. CLOUD, MN 56303-1901
(320) 251-2700
Mailing address
1900 CENTRACARE CIRCLE #2475, CENTRACARE HEALTH PLAZA, ST. CLOUD, MN 56303
(320) 229-5199
(320) 229-5109
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP5304
MN
Other
Enumeration date
12/08/2010
Last updated
12/08/2010
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