Thaddeus Wilderson
Clinical Child & Adolescent Psychologist
475 University Ave W
Saint Paul
, Minnesota 55103-1959
Thaddeus Wilderson
Clinical Child & Adolescent Psychologist
475 University Ave W
Saint Paul
, Minnesota 55103-1959
(651) 225-1697
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About
Features
Specialties
- Clinical Child & Adolescent Psychologist
Languages spoken
- English
Location
First Address
- Thaddeus Wilderson
- 475 University Ave W
- Saint Paul, MN
- Zip : 55103-1959
- Fax : (651) 225-1697
- Phone : (651) 225-8997
Second Address
- Thaddeus Wilderson
- 475 University Ave W
- Saint Paul, MN
- Zip : 55103-1959
- Fax : (651) 225-1697
- Phone : (651) 225-8997
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 103TC2200X | Clinical Child & Adolescent Psychologist | LP0061 | MN |
National Provider Identifier
| NPI | 1083029722 |
|---|---|
| Provider Name | Thaddeus Wilderson |
| First Address | Saint Paul, MN 55103-1959 |
| Second Address | Saint Paul, MN 55103-1959 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 20/06/2014 |
| Last Update Date | 20/06/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 1306973698 | (05) | MN |
| 1649362237 | (05) | MN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.