Provider Demographics
NPI:1710118054
Name:WYMAN-CHICK, KATHRYN ANNE (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANNE
Last Name:WYMAN-CHICK
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:ANNE
Other - Last Name:WYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-7900
Mailing Address - Fax:651-254-7904
Practice Address - Street 1:295 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-2400
Practice Address - Country:US
Practice Address - Phone:651-495-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6151103TC0700X, 103G00000X
VA0810005336103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program