Individual
JADE WISETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1811 S WASHINGTON ST, GRAND FORKS, ND 58201-6337
(701) 757-3045
Mailing address
1811 S WASHINGTON ST, GRAND FORKS, ND 58201-6337
(701) 757-3045
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1945
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1945
ST LICENSE
ND
Enumeration date
05/19/2021
Last updated
10/10/2024
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