Provider Demographics
NPI:1649568064
Name:ERWIN, WESLEY JON (PHD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:JON
Last Name:ERWIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8517
Mailing Address - Country:US
Mailing Address - Phone:651-784-3660
Mailing Address - Fax:
Practice Address - Street 1:1549 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8517
Practice Address - Country:US
Practice Address - Phone:651-784-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional