Provider Demographics
NPI:1700605490
Name:WISHEK, KRYSTA (PSYS)
Entity type:Individual
Prefix:MRS
First Name:KRYSTA
Middle Name:
Last Name:WISHEK
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DIVISION ST NW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-1641
Mailing Address - Country:US
Mailing Address - Phone:701-751-6500
Mailing Address - Fax:
Practice Address - Street 1:901 DIVISION ST NW
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-1641
Practice Address - Country:US
Practice Address - Phone:701-751-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND426684103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool