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NPI Code Detail

MEDICARE: MR. ANDREW W PAULSON PH.D

MEDICARE: MR. ANDREW W PAULSON PH.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist1852-057WI
2103T00000XPsychologistLP5007MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184804718
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANDREW W PAULSON PH.D
Provider Business Mailing Address
First Line : PO BOX 10657
Second Line :
City : SAINT PAUL
State : MN
Zip : 55110-0657
Country : US
Telephone Number : 651-300-9273
Fax Number : 651-447-7110
Provider Business Practice Location Address
First Line : 3501 ALDRICH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-4149
Country : US
Telephone Number : 651-300-9273
Fax Number : 651-447-7110
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2007
Last Update Date : 11/11/2021

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