Provider Demographics
NPI:1558557942
Name:WISTE WEBB, ALLISON (LCSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:WISTE WEBB
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 337TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-7597
Mailing Address - Country:US
Mailing Address - Phone:763-260-1996
Mailing Address - Fax:763-284-4404
Practice Address - Street 1:3700 337TH AVE NW
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-7597
Practice Address - Country:US
Practice Address - Phone:763-260-1996
Practice Address - Fax:763-284-4404
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149016652Medicare PIN