Provider Demographics
NPI:1043093636
Name:WANDREI PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:WANDREI PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WANDREI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:651-755-7875
Mailing Address - Street 1:1245 GUN CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3379
Mailing Address - Country:US
Mailing Address - Phone:651-755-7875
Mailing Address - Fax:
Practice Address - Street 1:1245 GUN CLUB RD
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3379
Practice Address - Country:US
Practice Address - Phone:651-755-7875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty