Organization
WOLFRAM ASSOCIATES, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY J. WOLFRAM PSYD, LP (PRESIDENT)
(320) 420-1146
Entity
Organization
Contact information
Practice address
2700 1ST ST N, SUITE 209, SAINT CLOUD, MN 56303-4256
(320) 420-1146
(320) 258-4380
Mailing address
5709 MEADOWLARK CT, SAINT CLOUD, MN 56303-0737
(320) 420-1146
(320) 258-4380
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
LP3758
MN
103TC0700X
Clinical Psychologist
Primary
LP3758
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101219
HEALTH PARTNERS
—
01
—
1014973
PREFERREDONE
—
05
—
174708800
—
MN
01
—
6102104
UNITED BEHAVIORAL HEALTH
—
01
—
71Q68WO
BLUECROSS BLUESHIELD
—
01
—
71Q69WO
BLUECROSS BLUESHIELD
—
Enumeration date
09/27/2006
Last updated
09/07/2012
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