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JAY PHILIP WISTROM LADC
NPI 1144587452
Counselor - Addiction (Substance Use Disorder) in Saint Cloud, MN

Active since April 12, 2012
1321 13TH ST N, SAINT CLOUD, MN 56303(320) 252-5010(320) 203-1855 Get Directions Write a Review

NPPES record last updated: April 12, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jay Philip Wistrom Ladc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JAY PHILIP WISTROM LADC (NPI 1144587452) is an individual addiction (substance use disorder) provider in Saint Cloud, Minnesota, licensed in Minnesota (303309) and active in the NPI registry since April 2012.

NPPES Registry Identity

NPI1144587452
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameJAY PHILIP WISTROMCredential: LADC
Location Address1321 13TH ST NSaint Cloud, MN 56303-2613
Mailing Address1321 13th St NSaint Cloud, MN 56303-2613 · (320) 252-5010 · Fax (320) 203-1855
Phone(320) 252-5010
Fax(320) 203-1855
Sole ProprietorNo
Enumeration DateApril 12, 2012
✔ NPI 1144587452 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in MN · 303309
1321 13TH ST N, Saint Cloud, MN 56303
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHERRI LYNN EICHERS PSY.D., LP
Psychologist (Clinical)
1321 13TH ST N
SAINT CLOUD, MN 56303
Stearns County (320) 252-5010
TONYA SHARON KLUG
Counselor (Addiction (Substance Use Disorder))
1321 13TH ST N
SAINT CLOUD, MN 56303
Stearns County (320) 252-5010
MS. CHARLOTTE ANN ROEBER NP
Nurse Practitioner (Adult Health)
1321 13TH ST N
SAINT CLOUD, MN 56303
Stearns County (320) 252-5010
MS. KATHRYN J ANDREWS MS LP
Psychologist
1321 13TH ST N
ST CLOUD, MN 56303
Stearns County (320) 252-5010
MR. STEVEN RINGSMUTH STOLPMAN MS, LMFT
Counselor (Mental Health)
1321 13TH ST N
SAINT CLOUD, MN 56303
Stearns County (320) 252-5010
GENOA HEALTHCARE LLC
Pharmacy (Long Term Care Pharmacy)
1321 13TH ST N, SUITE 100
SAINT CLOUD, MN 56303
Stearns County (320) 227-2744
DR. STEVEN VINCENT LOOS PSY.D, L.P.
Psychologist (Counseling)
1321 13TH ST N
SAINT CLOUD, MN 56303
Stearns County (320) 252-5010
ZACHARY COLE DORHOLT B.A.
Counselor (Mental Health)
1321 13TH ST N
SAINT CLOUD, MN 56303
Stearns County (320) 252-5010

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jay Wistrom's NPI number?

The NPI number for Jay Wistrom is 1144587452. It was assigned to this individual provider in the NPPES registry on April 12, 2012.

Where is Jay Wistrom located?

Jay Wistrom practices at 1321 13th St N, Saint Cloud, MN 56303. The listed phone number is (320) 252-5010.

What is Jay Wistrom's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Jay Wistrom was last updated on April 12, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.