Provider Demographics
NPI:1528636511
Name:DANIEL L WISE, PH.D., PA
Entity type:Organization
Organization Name:DANIEL L WISE, PH.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-875-4449
Mailing Address - Street 1:5200 WILLSON RD STE 205
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1343
Mailing Address - Country:US
Mailing Address - Phone:612-875-4449
Mailing Address - Fax:
Practice Address - Street 1:5200 WILLSON RD STE 205
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1343
Practice Address - Country:US
Practice Address - Phone:612-875-4449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty