Randy James Wills, MA LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP0388 Issued in MN

Practice address

13637 60TH St SW
Cokato, MN 55321-4210

Phone

(320) 286-2922

Fax

(320) 286-2875

NPI assigned

Oct 25, 2006

Last updated

Sep 25, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222300800000",
    "number": "1508941931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2346 ABBYWOOD LN",
            "city": "NORTH MANKATO",
            "state": "MN",
            "postal_code": "560034245",
            "telephone_number": "507-351-2920",
            "fax_number": "507-385-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13637 60TH ST SW",
            "city": "COKATO",
            "state": "MN",
            "postal_code": "553214210",
            "telephone_number": "320-286-2922",
            "fax_number": "320-286-2875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLS",
        "first_name": "RANDY",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "MA LP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2008-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP0388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MN",
            "identifier": "58528WI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BHP",
            "identifier": "120450",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "720851100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "K535",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea Verhey, OTR
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• Jesse Bassett Walker, LMFT
• Carrie Jo Weigman, DNP
• Jon Lee Wheeler, D.C.
• Gina M Young, DMD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; 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.