| Doctor Name: | RICHARD ALAN WANDERSEE |
| NPI Number: | 1083689624 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW LICSW |
| License Number: | 01593 |
| Business Practice Address: | 11475 Robinson Dr Nw Mail Stop 32600a Coon Rapids, MN - 554333746 |
| Business Phone Number: | 7637544600 |
| Business Fax Number: | 7637544614 |
| Mailing Address: | 8100 34th Ave S, 21110q BLOOMINGTON |
| State: | MN |
| Postal Code: | 554251672 |
| Phone Number: | 9528835790 |
| Fax Number: | 9528835395 |
| NPI Enumeration Date: | 02/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 01593 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |