Organization
THAD WILDERSON & ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RHONDA EAVES N/A (OFFICE & FINANCE MANAGER)
(651) 225-8997
Entity
Organization
Contact information
Practice address
475 UNIVERSITY AVE W, SAINT PAUL, MN 55103-1959
(651) 225-8997
Mailing address
475 UNIVERSITY AVE W, SAINT PAUL, MN 55103-1959
(651) 225-8997
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LP0061
MN
Other
Enumeration date
06/20/2014
Last updated
06/20/2014
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