Individual
JILLIAN JAE RISTAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPCC
Contact information
Practice address
215 SE 2ND AVE, GRAND RAPIDS, MN 55744-3615
(218) 326-1274
Mailing address
PO BOX 636, KEEWATIN, MN 55753-0636
(218) 244-3095
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
01757
MN
101YP2500X
Professional Counselor
Primary
2984
MN
Other
Enumeration date
11/05/2015
Last updated
09/02/2021
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