| Thad Wilderson & Associates Pa | |
|
475 University Ave W Saint Paul MN 55103-1959 | |
| (651) 225-8997 | |
| (651) 225-1967 |
| Full Name | Thad Wilderson & Associates Pa |
|---|---|
| Speciality | Case Management |
| Location | 475 University Ave W, Saint Paul, Minnesota |
| Authorized Official Name and Position | Thad Wilfred Wilderson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6512258997 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thad Wilderson & Associates Pa 475 University Ave W Saint Paul MN 55103-1959 Ph: (651) 225-8997 | Thad Wilderson & Associates Pa 475 University Ave W Saint Paul MN 55103-1959 Ph: (651) 225-8997 |
| NPI Number | 1306973698 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306973698 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | (* (Not Available)) | Primary |
| 251B00000X | Case Management | LP0061 (Minnesota) | Primary |
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