Provider Demographics
NPI:1083838213
Name:FRITSCHE, FERDE WILLIAM (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:FERDE
Middle Name:WILLIAM
Last Name:FRITSCHE
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 CALIFORNIA AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2105
Mailing Address - Country:US
Mailing Address - Phone:651-647-1653
Mailing Address - Fax:612-379-3183
Practice Address - Street 1:1313 5TH ST SE
Practice Address - Street 2:MAILBOX 45, SUITE 114 B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-4504
Practice Address - Country:US
Practice Address - Phone:512-819-7485
Practice Address - Fax:612-379-3183
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical