Individual
MARY LYNN WIDSETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2700 1ST ST N # 204, SAINT CLOUD, MN 56303-4256
(320) 250-7997
Mailing address
828 22ND AVE N, SAINT CLOUD, MN 56303-2503
(320) 250-7997
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2100
MN
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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