Healthcare Provider Details

I. General information

NPI: 1225034408
Provider Name (Legal Business Name): PAUL THOMAS HIRDMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 HENDON AVE
SAINT PAUL MN
55108-1421
US

IV. Provider business mailing address

2222 HENDON AVE
SAINT PAUL MN
55108-1421
US

V. Phone/Fax

Practice location:
  • Phone: 651-983-8011
  • Fax:
Mailing address:
  • Phone: 651-983-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP1786
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: