Healthcare Provider Details

I. General information

NPI: 1871428110
Provider Name (Legal Business Name): KRISTIN WETZEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 METRO BLVD STE 227
EDINA MN
55439-2470
US

IV. Provider business mailing address

5836 CREEK VALLEY RD
EDINA MN
55439-1212
US

V. Phone/Fax

Practice location:
  • Phone: 612-712-5244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14868
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: