Individual
JESSICA DEIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1891 STATION PKWY NW, ANDOVER, MN 55304-4259
(763) 755-4275
(763) 755-4261
Mailing address
1891 STATION PKWY NW, ANDOVER, MN 55304-4259
(763) 755-4275
(763) 755-4261
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104768
MN
Other
Enumeration date
09/30/2014
Last updated
10/20/2016
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