Provider Demographics
NPI:1043481658
Name:NADOLNY, EDMUND EDWARD (PHD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:EDWARD
Last Name:NADOLNY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-0495
Mailing Address - Country:US
Mailing Address - Phone:320-235-3004
Mailing Address - Fax:320-235-3008
Practice Address - Street 1:1000 WILLMAR AVE SW
Practice Address - Street 2:BEHAVIORAL FORENSIC SERVICES
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3067
Practice Address - Country:US
Practice Address - Phone:320-235-3004
Practice Address - Fax:320-235-3008
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-23
Last Update Date:2008-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0891103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic