Thad Wilderson & Associates PA

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Legal business name

THAD WILDERSON & ASSOCIATES PA

Practice address

475 University Ave W
Saint Paul, MN 55103-1959

Phone

(651) 225-8997

Fax

(651) 225-1967

NPI assigned

Feb 27, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Thad Wilfred Wilderson, LP

Title

Executive Director

Phone

(651) 225-8997

Specialties & licenses 2

Addresses

Tax ID family

Thad Wilderson Associates PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Thad Wilderson & Associates PA

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1073928701
  NPD tax ID
• Thad Wilderson & Associates PA

  • Clinical Child & Adolescent Psychologist
  • Saint Paul, MN
  • NPI 1649362237
  NPD tax ID

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1306973698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551031959",
            "telephone_number": "651-225-8997",
            "fax_number": "651-225-1967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551031959",
            "telephone_number": "651-225-8997",
            "fax_number": "651-225-1967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THAD WILDERSON & ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "WILDERSON",
        "authorized_official_first_name": "THAD",
        "authorized_official_middle_name": "WILFRED",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-225-8997",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LP"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "MN",
            "license": "LP0061",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Jean Tessier, RN, PHN
• Brett Walter Teten, MD
• Alden R Tetlie, MD
• Daniel Texidor, PA-C
• Thad Wilderson & Associates PA
• Thad Wilderson & Associates PA
• Christopher C Thaemert, D.C.
• Nina D Thai, D.D.S
• Surabhi B. Thakar, MBBS
• Lindy Thaker, MD

• Clinical Child & Adolescent Psychologist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Child & Adolescent Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.