Provider Demographics
NPI:1841660198
Name:WETROSKY, DEBRA SUSAN (MS, LMFT)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:SUSAN
Last Name:WETROSKY
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-0547
Mailing Address - Country:US
Mailing Address - Phone:763-221-7707
Mailing Address - Fax:
Practice Address - Street 1:5842 OLD MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-6698
Practice Address - Country:US
Practice Address - Phone:651-401-3067
Practice Address - Fax:651-674-2534
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2984106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist