Provider Demographics
NPI:1164187639
Name:KNISKERN, PATRICIA JEAN (PSY D, MA)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JEAN
Last Name:KNISKERN
Suffix:
Gender:F
Credentials:PSY D, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 HIGHWAY 35 N
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-6746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7039 20TH AVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MN
Practice Address - Zip Code:55038-9737
Practice Address - Country:US
Practice Address - Phone:651-288-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty