| Melissa K Wetterlund Llc | |
|
4255 Pheasant Ridge Dr Ne Ste 412 Blaine MN 55449-5066 | |
| (763) 703-3754 | |
| (763) 703-3725 |
| Full Name | Melissa K Wetterlund Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4255 Pheasant Ridge Dr Ne Ste 412, Blaine, Minnesota |
| Authorized Official Name and Position | Melissa Wetterlund (OWNER) |
| Authorized Official Contact | 6127477138 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Melissa K Wetterlund Llc 4255 Pheasant Ridge Dr Ne Ste 412 Blaine MN 55449-5066 Ph: (763) 703-3749 | Melissa K Wetterlund Llc 4255 Pheasant Ridge Dr Ne Ste 412 Blaine MN 55449-5066 Ph: (763) 703-3754 |
| NPI Number | 1588309181 |
|---|---|
| Provider Enumeration Date | 04/28/2022 |
| Last Update Date | 01/15/2024 |
| Certification Date | 01/15/2024 |
| Medicare PECOS PAC ID | 5698127751 |
|---|---|
| Medicare Enrollment ID | O20240115000825 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588309181 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Melissa Wetterlund |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1659413599 PECOS PAC ID: 6507218666 Enrollment ID: I20240116000810 |
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