Individual
JENNY WETTERSTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LP
Contact information
Practice address
1215 SE 7TH AVE, GRAND RAPIDS, MN 55744-4201
(218) 313-1316
(218) 327-1932
Mailing address
215 SE 2ND AVE, GRAND RAPIDS, MN 55744-3615
(218) 313-1316
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3555
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010749
PREFERRED ONE
MN
01
—
62 42586
UNITED BEHAVIORAL SYSTEMS
MN
01
—
8H460WE
BCBS OF MINNESOTA
MN
Enumeration date
05/10/2007
Last updated
07/08/2007
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