Provider Demographics
NPI:1659864601
Name:WETLI, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WETLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 LEXINGTON AVE N STE 100
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8048
Mailing Address - Country:US
Mailing Address - Phone:651-583-5565
Mailing Address - Fax:651-583-5566
Practice Address - Street 1:3550 LEXINGTON AVE N STE 100
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8048
Practice Address - Country:US
Practice Address - Phone:651-583-5565
Practice Address - Fax:651-583-5566
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN255311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health