Provider Demographics
NPI:1093530883
Name:DUE, MILO WILDER (PSYD LP)
Entity type:Individual
Prefix:DR
First Name:MILO
Middle Name:WILDER
Last Name:DUE
Suffix:
Gender:X
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 ELLIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2636
Mailing Address - Country:US
Mailing Address - Phone:612-968-5614
Mailing Address - Fax:
Practice Address - Street 1:2101 MINNEHAHA AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3107
Practice Address - Country:US
Practice Address - Phone:612-721-1204
Practice Address - Fax:612-721-9850
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP7115103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist