Individual
MARY LOUISE WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., L.P.
Contact information
Practice address
2 E. FRANKLIN AVE., #6, MPLS, MN 55403
(952) 451-8199
Mailing address
2 E. FRANKLIN AVE., #6, MPLS, MN 55403
(952) 451-8199
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
LP2784
MN
103TC0700X
Clinical Psychologist
Primary
LP2784
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19356WI
BLUE CROSS BLUE SHIELD MN
MN
01
—
1F233WI
BCBS INDIVIDUAL #
MN
Enumeration date
03/08/2006
Last updated
09/11/2025
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