Ken Wadum, Ed.D. LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP2777 Issued in MN

Legal business name

KEN WADUM, ED.D. LP

Practice address

1530 Greenview Dr SW
Suite 207
Rochester, MN 55902-4286

Phone

(507) 280-0225

NPI assigned

Sep 26, 2012

Organization subpart

Yes

Parent organization

KEN WADUM, ED.D., LPAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth Charles Wadum, ED.D.NPI 1225191976

Title

Owner

Phone

(507) 280-0225

Specialties & licenses 1

Addresses

Part of

Ken Wadum Edd LP

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth Charles Wadum, ED.D.

  • Clinical Psychologist
  • Rochester, MN
  • NPI 1225191976
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348617600000",
    "number": "1043561335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 GREENVIEW DR SW",
            "address_2": "SUITE 207",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559024286",
            "telephone_number": "507-280-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 GREENVIEW DR SW",
            "address_2": "SUITE 207",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559024286",
            "telephone_number": "507-280-0225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEN WADUM, ED.D. LP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEN WADUM, ED.D., LP",
        "enumeration_date": "2012-09-26",
        "last_updated": "2012-09-26",
        "status": "A",
        "authorized_official_last_name": "WADUM",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-280-0225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP2777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary Kelm, M.D., PH.D.
• John William Kelsey, M.D.
• Roger D Kempers, MD
• Patricia Kempinger
• Jennifer Leah Kemppainen, MS, CGC
• Maral D Kenderian, MD
• Saad J Kenderian, MD
• Vera Kenderian, DDS
• Mustafa Kendi, M.D.
• Kendra R Henry LLC

• Psychologist in Rochester, MN
• Providers in Rochester, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.