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General NPI Number Information
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NPI Number | 1417459215
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Entity Type | Individual
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Provider Name | THOMAS VINCENT WAIT LICSW
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Gender | Male
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 700 CEDAR ST
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City | ALEXANDRIA
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State | MN
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Zip | 56308-1769
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Country | US
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Telephone | 218-851-8498
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Fax |
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Provider Business Mailing Address
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Address Line | 105 2ND AVE NE
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City | GLENWOOD
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State | MN
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Zip | 56334-9257
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Country | US
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Telephone | 218-851-8498
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 29723
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License Number State | MN
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