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Individual

KATIE MICHELLE NYSTROM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LICSW, MSW

Contact information

Practice address
320 EAST MAIN ST, CROSBY, MN 56441
(218) 546-7000
(218) 546-4400
Mailing address
320 EAST MAIN ST, CROSBY, MN 56441
(218) 546-7000
(218) 546-4400

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
21668
MN

Other

Enumeration date
04/08/2021
Last updated
11/29/2021
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