Provider Demographics
NPI:1104868421
Name:AIKEN, TRICIA L (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:L
Last Name:AIKEN
Suffix:
Gender:F
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 1:302 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3605
Mailing Address - Country:US
Mailing Address - Phone:507-388-8114
Mailing Address - Fax:507-387-7368
Practice Address - Street 1:302 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3605
Practice Address - Country:US
Practice Address - Phone:507-388-8114
Practice Address - Fax:507-387-7368
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4540103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN755295500Medicaid
MN84732OtherHEALTH PARTNERS GR#
MN060H0ASOtherMN BLUE CROSS GROUP #