NPIMap

Organization Active NPI

Thad Wilderson & Associates PA

  • Clinical Child & Adolescent Psychologist
  • Saint Paul, MN
National Provider Identifier
1649362237
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
LP0061 Issued in MN
Legal business name
THAD WILDERSON & ASSOCIATES PA
Practice address
475 University Ave W
Saint Paul, MN 55103-1959
Phone
(651) 225-8997
Fax
(651) 225-1697
NPI assigned
Sep 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC2200X LP0061 MN Primary

Addresses

Primary practice location

475 University Ave W
Saint Paul, MN 55103-1959

Mailing address

475 University Ave W
Saint Paul, MN 55103-1959
Phone (651) 225-8997

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649362237",
    "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": "651-225-1697"
        },
        {
            "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": "651-225-1697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THAD WILDERSON & ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2020-08-22",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP0061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.