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Organization

THAD WILDERSON & ASSOCIATES PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. THAD WILFRED WILDERSON LP (EXECUTIVE DIRECTOR)
(651) 225-8997
Entity
Organization

Contact information

Practice address
475 UNIVERSITY AVE W, SAINT PAUL, MN 55103-1959
(651) 225-8997
(651) 225-1697
Mailing address
475 UNIVERSITY AVE W, SAINT PAUL, MN 55103-1959
(651) 225-8997
(651) 225-1697

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
LP0061
MN

Other

Enumeration date
09/29/2006
Last updated
08/22/2020
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