Provider Demographics
NPI:1093722837
Name:PARDUN, PATRICIA A (MS, LMFT, LADC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:PARDUN
Suffix:
Gender:F
Credentials:MS, LMFT, LADC
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 146
Mailing Address - Street 2:
Mailing Address - City:MARINE ON SAINT CROIX
Mailing Address - State:MN
Mailing Address - Zip Code:55047-0146
Mailing Address - Country:US
Mailing Address - Phone:651-433-2130
Mailing Address - Fax:651-433-5930
Practice Address - Street 1:521 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2016
Practice Address - Country:US
Practice Address - Phone:651-433-5400
Practice Address - Fax:651-433-5930
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300371101YA0400X
MN1297106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN121482900OtherMEDICAL ASSISTANCE PROV.