Provider Demographics
NPI:1003991936
Name:PATTERSON, ROBERT G (EDD LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:G
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:EDD LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
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Mailing Address - Street 1:405 8TH AVE NW
Mailing Address - Street 2:SUITE 333
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401
Mailing Address - Country:US
Mailing Address - Phone:605-225-3622
Mailing Address - Fax:605-229-2719
Practice Address - Street 1:405 8TH AVE NW
Practice Address - Street 2:SUITE 333
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401
Practice Address - Country:US
Practice Address - Phone:605-225-3622
Practice Address - Fax:605-229-2719
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD149103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6550013Medicaid
SD6550013Medicaid