Provider Demographics
NPI:1578685681
Name:WISKUS, BETH ANNE (MA, MT-BC, NMT)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANNE
Last Name:WISKUS
Suffix:
Gender:F
Credentials:MA, MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-5412
Mailing Address - Country:US
Mailing Address - Phone:612-251-8991
Mailing Address - Fax:
Practice Address - Street 1:1616 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5412
Practice Address - Country:US
Practice Address - Phone:612-251-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA520004100OtherMN PROVIDER IDENTIFIER