Provider Demographics
NPI:1992689814
Name:EFFERTZ, WAYNE MICHAEL (CPRS, MA, LADC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:MICHAEL
Last Name:EFFERTZ
Suffix:
Gender:M
Credentials:CPRS, MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 132ND LN NW
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-2570
Mailing Address - Country:US
Mailing Address - Phone:651-315-2908
Mailing Address - Fax:
Practice Address - Street 1:2311 WOODBRIDGE ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4710
Practice Address - Country:US
Practice Address - Phone:651-773-0832
Practice Address - Fax:651-773-9115
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN830320-2-CDT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health