Provider Demographics
NPI:1184804718
Name:PAULSON, ANDREW W (PHD)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:W
Last Name:PAULSON
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 10657
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55110-0657
Mailing Address - Country:US
Mailing Address - Phone:651-300-9273
Mailing Address - Fax:651-447-7110
Practice Address - Street 1:3501 ALDRICH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4149
Practice Address - Country:US
Practice Address - Phone:651-300-9273
Practice Address - Fax:651-447-7110
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1852-057103T00000X
MNLP5007103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39649900Medicaid