Provider Demographics
NPI:1194230045
Name:FRIEDMAN, PATRICIA JOANN (LADC BCC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JOANN
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:LADC BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 OLD CEDAR AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1205
Mailing Address - Country:US
Mailing Address - Phone:952-693-0080
Mailing Address - Fax:952-955-6567
Practice Address - Street 1:8040 OLD CEDAR AVE S STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1205
Practice Address - Country:US
Practice Address - Phone:952-693-0080
Practice Address - Fax:952-955-6567
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304163101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN304163OtherLADC