MEDICARE: DR. WARREN H PHILLIPS PH, D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	00842	IA
2	103T00000X	Psychologist	356	IA
3	103TB0200X	Cognitive & Behavioral Psychologist	00842	IA
4	103TC2200X	Clinical Child & Adolescent Psychologist	00842	IA
5	103T00000X	Psychologist	0006871	CO
6	103TC0700X	Clinical Psychologist	00842	IA
7	103TM1800X	Intellectual & Developmental Disabilities Psychologist	00842	IA

General Provider Information

NPI Number	:	1083705917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WARREN H PHILLIPS PH, D.

Provider Business Mailing Address
First Line	:	400 S 4TH ST STE 400
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-1419
Country	:	US
Telephone Number	:	970-201-1774
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S 4TH ST STE 400
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-1419
Country	:	US
Telephone Number	:	970-201-1774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	11/20/2025

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