Individual
MR. RANDY JAMES WILLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA LP
Contact information
Practice address
13637 60TH ST SW, COKATO, MN 55321-4210
(320) 286-2922
(320) 286-2875
Mailing address
2346 ABBYWOOD LN, NORTH MANKATO, MN 56003-4245
(507) 351-2920
(507) 385-2090
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP0388
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120450
BHP
MN
01
—
58528WI
BLUE CROSS OF MN
MN
05
—
720851100
—
MN
01
—
K535
UCARE
MN
Enumeration date
10/25/2006
Last updated
09/25/2008
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