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General NPI Number Information
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NPI Number | 1679664254
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Entity Type | Organization
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Legal Business Name | WOLFRAM ASSOCIATES, LTD.
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 2700 1ST ST N SUITE 209
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City | SAINT CLOUD
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State | MN
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Zip | 56303-4256
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Country | US
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Telephone | 320-420-1146
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Fax | 320-258-4380
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Provider Business Mailing Address
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Address Line | 5709 MEADOWLARK CT
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City | SAINT CLOUD
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State | MN
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Zip | 56303-0737
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Country | US
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Telephone | 320-420-1146
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Fax | 320-258-4380
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY J. WOLFRAM
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Credential | PSYD, LP
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Telephone | 320-420-1146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | LP3758
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP3758
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License Number State | MN
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