Individual
JACOB WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW
Contact information
Practice address
310 E 38TH ST STE 322, MINNEAPOLIS, MN 55409-1300
(612) 824-0415
Mailing address
310 E 38TH ST STE 322, MINNEAPOLIS, MN 55409-1300
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
31345
MN
Other
Enumeration date
03/20/2025
Last updated
03/20/2025
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