Provider Demographics
NPI:1215298179
Name:WALDRON, ERIC JOHN (PHD, LP, ABPP)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOHN
Last Name:WALDRON
Suffix:
Gender:M
Credentials:PHD, LP, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FULTON ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-4800
Mailing Address - Country:US
Mailing Address - Phone:612-626-6688
Mailing Address - Fax:612-624-4458
Practice Address - Street 1:909 FULTON ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-4800
Practice Address - Country:US
Practice Address - Phone:612-626-6688
Practice Address - Fax:612-624-4458
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001258103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist