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General NPI Number Information
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NPI Number | 1396750188
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Entity Type | Organization
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Legal Business Name | NYSTROM & ASSOCIATES, LTD
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 1900 SILVER LAKE RD NW SUITE 110
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-1786
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Country | US
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Telephone | 651-628-9566
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Fax | 651-628-0411
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Provider Business Mailing Address
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Address Line | 1900 SILVER LAKE RD NW STE 110
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-1789
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Country | US
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Telephone | 651-628-9566
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Fax | 651-628-0411
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | ANN EIDEN
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Credential |
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Telephone | 651-379-1750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0145
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 06197
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License Number State | MN
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