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General NPI Number Information
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NPI Number | 1992689814
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Entity Type | Individual
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Provider Name | WAYNE MICHAEL EFFERTZ CPRS, MA, LADC
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Gender | Male
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 2311 WOODBRIDGE ST
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City | ROSEVILLE
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State | MN
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Zip | 55113-4710
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Country | US
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Telephone | 651-773-0832
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Fax | 651-773-9115
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Provider Business Mailing Address
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Address Line | 2324 132ND LN NW
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City | MINNEAPOLIS
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State | MN
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Zip | 55448-2570
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Country | US
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Telephone | 651-315-2908
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 830320-2-CDT
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License Number State | MN
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