Provider Demographics
NPI:1780025551
Name:WILTZIUS, ABBEY LYNN (LAMFT)
Entity Type:Individual
Prefix:MS
First Name:ABBEY
Middle Name:LYNN
Last Name:WILTZIUS
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SNELLING AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1944
Mailing Address - Country:US
Mailing Address - Phone:651-699-6480
Mailing Address - Fax:651-699-4889
Practice Address - Street 1:232 SNELLING AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1944
Practice Address - Country:US
Practice Address - Phone:651-699-6480
Practice Address - Fax:651-699-4889
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist