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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