Organization
W WADE PHD LP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WENDY ANN WADE PHD LP (OWNER)
(612) 385-6392
Entity
Organization
Contact information
Practice address
4500 PARK GLEN RD, SUITE 270, ST LOUIS PARK, MN 55416-4871
(952) 929-9478
(952) 929-9548
Mailing address
4500 PARK GLEN RD, SUITE 270, ST LOUIS PARK, MN 55416-4871
(952) 929-9478
(952) 929-9548
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
LP5259
MN
Other
Enumeration date
02/01/2011
Last updated
02/01/2011
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