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Individual

MRS. HEIDI PARK WISTE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LICSW

Contact information

Practice address
2230 COMO AVE, SAINT PAUL, MN 55108-1720
(651) 635-0095
(651) 635-0454
Mailing address
2230 COMO AVE, SAINT PAUL, MN 55108-1720
(651) 635-0095
(651) 635-0454

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
15091
MN

Other

Enumeration date
11/15/2006
Last updated
03/18/2009
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