Healthcare Provider Details

I. General information

NPI: 1316744709
Provider Name (Legal Business Name): ERIN MCKAY WARDZALA PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 FAIRVIEW AVE N STE 100
ROSEVILLE MN
55113-1306
US

IV. Provider business mailing address

2720 FAIRVIEW AVE N STE 100
ROSEVILLE MN
55113-1306
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-5290
  • Fax:
Mailing address:
  • Phone: 651-241-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberLP7152
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberLP7152
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP7152
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: