Provider Demographics
NPI:1962382796
Name:VETTER, DAVID ARMIN JR
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ARMIN
Last Name:VETTER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 ANCHOR DR APT 332
Mailing Address - Street 2:
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-6049
Mailing Address - Country:US
Mailing Address - Phone:651-274-5844
Mailing Address - Fax:
Practice Address - Street 1:467 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-1402
Practice Address - Country:US
Practice Address - Phone:952-208-1577
Practice Address - Fax:651-330-3177
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician