Provider Demographics
NPI:1205022753
Name:PAQUIN, AMELIA S (PHD LP)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:S
Last Name:PAQUIN
Suffix:
Gender:F
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 1:1303 S FRONTAGE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-2690
Mailing Address - Country:US
Mailing Address - Phone:612-469-1963
Mailing Address - Fax:855-344-4350
Practice Address - Street 1:1303 S FRONTAGE RD
Practice Address - Street 2:STE 219
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033
Practice Address - Country:US
Practice Address - Phone:651-505-3273
Practice Address - Fax:855-344-4350
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4849103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical