Provider Demographics
NPI:1518791334
Name:WADHWA, JYOTI
Entity type:Individual
Prefix:
First Name:JYOTI
Middle Name:
Last Name:WADHWA
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 1:6225 WAKEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-7099
Mailing Address - Country:US
Mailing Address - Phone:612-325-1749
Mailing Address - Fax:
Practice Address - Street 1:6225 WAKEFIELD CT
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-7099
Practice Address - Country:US
Practice Address - Phone:612-325-1749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN179611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical