Healthcare Provider Details

I. General information

NPI: 1053245266
Provider Name (Legal Business Name): CHAD RUSSELL WILKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 FINN ST S
SAINT PAUL MN
55105-1012
US

IV. Provider business mailing address

35 FINN ST S
SAINT PAUL MN
55105-1012
US

V. Phone/Fax

Practice location:
  • Phone: 651-962-6750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: