Active NPI
Timothy J. Wolfram, PSYD
- Clinical Psychologist
- Saint Cloud, MN
National Provider Identifier
1689874539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP 3758
- Practice address
- 4801 Veterans Dr
Saint Cloud, MN 56303-2015 - Phone
- (320) 252-1670
- NPI assigned
- Jul 19, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | LP 3758 | MN | |
| Clinical Psychologist | 103TC0700X | LP 3758 | MN | Primary |
Addresses
Primary practice location
4801 Veterans Dr
Saint Cloud, MN 56303-2015
Mailing address
4801 Veterans Dr
Saint Cloud, MN 56303-2015
Phone (320) 252-1670
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP 3758 | MN | MD | Clinical Neuropsychologist |
| 3758 | MN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184803200000",
"number": "1689874539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4801 VETERANS DR",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563032015",
"telephone_number": "320-252-1670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4801 VETERANS DR",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563032015",
"telephone_number": "320-252-1670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLFRAM",
"first_name": "TIMOTHY",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-19",
"last_updated": "2007-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MN",
"license": "LP 3758",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP 3758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.