Organization
SURDY PSYCHOLOGICAL SERVICES LLC
Active
Organization
SURDY PSYCHOLOGICAL SERVICES LLC
Active
Other names
Mending Roots
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORE SURDY PH.D (CEO)
(507) 388-8874
Entity
Organization
Contact information
Practice address
1227 CALEDONIA ST, MANKATO, MN 56001-4329
(507) 388-8874
(507) 625-4807
Mailing address
1227 CALEDONIA ST, MANKATO, MN 56001-4329
(507) 388-8874
(507) 625-4807
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP3385
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06T04SU
BXBS
MN
01
—
114945
UCARE MINNESOTA
MN
05
—
497823400
—
MN
01
—
HP28628
HEALTH PARTNERS
MN
Enumeration date
02/10/2017
Last updated
01/22/2025
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