| Daniel L Wise, Ph.d., Pa | |
|
5200 Willson Rd Ste 205 Edina MN 55424-1343 | |
| (612) 875-4449 | |
| Not Available |
| Full Name | Daniel L Wise, Ph.d., Pa |
|---|---|
| Speciality | Psychologist |
| Location | 5200 Willson Rd Ste 205, Edina, Minnesota |
| Authorized Official Name and Position | Daniel Wise (PRESIDENT/LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 6128754449 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Daniel L Wise, Ph.d., Pa 5200 Willson Rd Ste 205 Minneapolis MN 55424-1343 Ph: (612) 875-4449 | Daniel L Wise, Ph.d., Pa 5200 Willson Rd Ste 205 Edina MN 55424-1343 Ph: (612) 875-4449 |
| NPI Number | 1528636511 |
|---|---|
| Provider Enumeration Date | 06/15/2021 |
| Last Update Date | 08/24/2021 |
| Certification Date | 08/24/2021 |
| Medicare PECOS PAC ID | 2860880374 |
|---|---|
| Medicare Enrollment ID | O20211102000760 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528636511 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Daniel L Wise |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245465558 PECOS PAC ID: 0446389993 Enrollment ID: I20200325001136 |
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