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General NPI Number Information
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NPI Number | 1043481658
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Entity Type | Individual
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Provider Name | EDMUND EDWARD NADOLNY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2008
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Last Update Date | 03/23/2008
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Provider Practice Location Address
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Address Line | 1000 WILLMAR AVE SW BEHAVIORAL FORENSIC SERVICES
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City | WILLMAR
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State | MN
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Zip | 56201-3067
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Country | US
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Telephone | 320-235-3004
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Fax | 320-235-3008
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Provider Business Mailing Address
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Address Line | PO BOX 495
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City | WILLMAR
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State | MN
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Zip | 56201-0495
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Country | US
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Telephone | 320-235-3004
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Fax | 320-235-3008
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | LP0891
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License Number State | MN
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