THADDEUS WILDERSON (NPI# 1083029722) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083029722 |
| Entity Type | Individual |
| Full Name | THADDEUS WILDERSON |
| Practice Address |
475 University Ave W Saint Paul MN 55103-1959 |
| Practice Telephone | 6512258997 |
| Practice Fax Number | 6512251697 |
| Mailing Telephone | 6512258997 |
| Mailing Fax Number | 6512251697 |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2014-06-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
LP0061 | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 1306973698 | 05 | |
| MN | 1649362237 | 05 |
| Street Address |
475 UNIVERSITY AVE W |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55103-1959 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649362237 | Thad Wilderson & Associates Pa | Psychologist | 475 University Ave W, Saint Paul, MN 55103-1959 | 2006-09-29 |
| 1932606878 | Charlotte Dawn Johnson | Counselor | 475 University Ave W, Saint Paul, MN 55103-1959 | 2018-04-08 |
| 1073928701 | Thad Wilderson & Associates Pa | Community/Behavioral Health | 475 University Ave W, Saint Paul, MN 55103-1959 | 2014-06-20 |
| 1871770479 | Hynan Chiropractic Clinic | Clinic/Center | 475 University Ave W, Saint Paul, MN 55103-1959 | 2008-01-25 |
| 1306973698 | Thad Wilderson & Associates Pa | Psychologist | 475 University Ave W, Saint Paul, MN 55103-1959 | 2007-02-27 |
| 1427137298 | Gregory J. Hynan | Chiropractor | 475 University Ave W, Saint Paul, MN 55103-1959 | 2006-11-03 |
| 1841379674 | John J Hynan | Chiropractor | 475 University Ave W, Saint Paul, MN 55103-1959 | 2006-11-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972148161 | Najma Group Home LLC | Home Health | 494 Aurora Ave, St Paul, MN 55103 | 2019-11-12 |
| 1164910121 | Linda's A Mother's Touch | Registered Nurse | 727 Front Ave Apt 606, St. Paul, MN 55103 | 2018-04-25 |
| 1215432380 | Olidia Transit Inc | Non-emergency Medical Transport (VAN) | 476 W Minnehaha Ave, Saint Paul, MN 55103 | 2018-03-29 |
| 1730579764 | Leah Angela Vibar | Chiropractor | 616 Rice Street Ste. B, Moua-lor Chiropractic & Acupuncture, P.a., St. Paul, MN 55103 | 2015-01-29 |
| 1629372479 | Korme Koji | Registered Nurse | 413 Central Avenue, St Paul, MN 55103 | 2011-01-07 |
| 1427360114 | Olydia Home Care Inc | Home Health | 476 West Minnehaha Ave, Saint Paul, MN 55103 | 2010-07-09 |
| 1699908277 | Kathleen Mae Borchert | Clinical Nurse Specialist | 559 Capitol Bloulevard, St. Paul, MN 55103 | 2009-08-28 |
| 1164690442 | Chong Pao Thao | Technician | 23 Empire Drive, Suite 123, St Paul, MN 55103 | 2008-02-20 |
| 1245366806 | Quality Plus Home Healthcare Services Inc | Home Health | 383 University Ave W. Upper, St Paul, MN 55103 | 2007-02-26 |
| 1023176286 | Amherst H. Wilder Foundation | Assisted Living Facility | 280 Ravoux St, Saint Paul, MN 55103 | 2006-12-04 |
| Find all providers in zip 55103 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649362237 | Thad Wilderson & Associates Pa | Psychologist | 475 University Ave W, Saint Paul, MN 55103-1959 | 2006-09-29 |
| 1619461597 | Sandra Ahumada | Psychologist | 360 Sherman St Ste 200, Saint Paul, MN 55102 | 2018-06-14 |
| 1841738176 | Wendi Schirvar | Psychologist | 1360 Energy Park Dr, #340, Saint Paul, MN 55108-5276 | 2017-02-07 |
| 1760786883 | Abigail Hughes-scalise | Psychologist | 225 Smith Ave N, Suite 201, Saint Paul, MN 55102-2533 | 2011-01-04 |
| 1639388747 | Elizabeth Carlson | Psychologist | 570 Asbury St, Saint Paul, MN 55104-1849 | 2007-05-22 |
| 1043330426 | Kristin Muyskens | Psychologist | 709 University Ave W, Saint Paul, MN 55104-4804 | 2007-03-30 |
| 1306973698 | Thad Wilderson & Associates Pa | Psychologist | 475 University Ave W, Saint Paul, MN 55103-1959 | 2007-02-27 |
| 1669546479 | Sandra Kay Hewitt | Psychologist | 570 Asbury St, Suite 310, Saint Paul, MN 55104-1849 | 2006-11-20 |
| 1801989157 | Linda Budd | Psychologist | 2301 Como Ave, Suite 204, Saint Paul, MN 55108-1718 | 2006-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316405202 | Q Collective, LLC | Psychologist | 3413 Wilshire Pl Ne, Minneapolis, MN 55418-1447 | 2019-03-09 |
| 1043714199 | Julianna Sapienza | Psychologist | 2545 Chicago Ave Ste 217, Minneapolis, MN 55404-4556 | 2018-03-22 |
| 1942758701 | Dana Hoehn | Psychologist | 4636 Lyndale Ave S, Lower Unit, Minneapolis, MN 55419-5302 | 2016-09-21 |
| 1942687397 | Hope Psychology Practice, LLC | Psychologist | 2720 W. 43rd St., Suite 205, Minneapolis, MN 55410 | 2015-05-05 |
| 1861737041 | Decisionpoint Behavioral Health, Inc. | Psychologist | 206 S Broadway, Suite 411a, Rochester, MN 55904-6502 | 2012-11-29 |
| 1063725166 | Thomas Robert Lutz | Psychologist | 1125 Ramsey St, Hastings, MN 55033-2811 | 2010-07-17 |
| 1366755597 | Kristin L Ballard | Psychologist | 4005 W 65th St Ste 110, Edina, MN 55435-1700 | 2010-07-16 |
| 1316180011 | Brenda Diane Brant | Psychologist | 18473 97th Pl N, Maple Grove, MN 55311-1368 | 2009-04-09 |
| 1457554735 | Catherine Lawrence Scharlau | Psychologist | 1295 Bandana Blvd. North, Aspen Medical Group-behavioral Health, St. Paul, MN 55108 | 2007-06-06 |
| 1710196522 | Bill J Duke | Psychologist | 420 Center Ave Ste 7, Moorhead, MN 56560-1962 | 2007-05-21 |
| Find all providers with the same taxonomy | ||||
| City | SAINT PAUL |
| Zip Code | 55103 |
Please comment or provide details below to improve the information on THADDEUS WILDERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.