Healthcare Provider Details

I. General information

NPI: 1043481658
Provider Name (Legal Business Name): EDMUND EDWARD NADOLNY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2008
Last Update Date: 03/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WILLMAR AVE SW BEHAVIORAL FORENSIC SERVICES
WILLMAR MN
56201-3067
US

IV. Provider business mailing address

PO BOX 495
WILLMAR MN
56201-0495
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-3004
  • Fax: 320-235-3008
Mailing address:
  • Phone: 320-235-3004
  • Fax: 320-235-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberLP0891
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: