Provider Demographics
NPI:1114799301
Name:HOISTAD, ANDREW CLARK
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:CLARK
Last Name:HOISTAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7445 HUMBOLDT AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-3827
Mailing Address - Country:US
Mailing Address - Phone:651-324-3051
Mailing Address - Fax:
Practice Address - Street 1:1245 GUN CLUB RD
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3379
Practice Address - Country:US
Practice Address - Phone:612-644-4887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor