Provider Demographics
NPI:1659413599
Name:WETTERLUND, MELISSA (MA, LP, LMFT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WETTERLUND
Suffix:
Gender:F
Credentials:MA, LP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 PHEASANT RIDGE DR NE STE 412
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5066
Mailing Address - Country:US
Mailing Address - Phone:763-703-3749
Mailing Address - Fax:651-393-2835
Practice Address - Street 1:4255 PHEASANT RIDGE DR NE STE 412
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5066
Practice Address - Country:US
Practice Address - Phone:763-703-3749
Practice Address - Fax:763-703-3725
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLMFT 1867106H00000X
MNLMFT1867106H00000X
MNLP 5014103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist