Provider Demographics
NPI:1235173956
Name:PRINDAVILLE, PATRICIA (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:PRINDAVILLE
Suffix:
Gender:F
Credentials:PHD
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 747
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66505-0747
Mailing Address - Country:US
Mailing Address - Phone:785-587-4300
Mailing Address - Fax:785-587-4377
Practice Address - Street 1:210 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-5200
Practice Address - Country:US
Practice Address - Phone:785-243-8900
Practice Address - Fax:785-243-8933
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0486103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119781OtherBCBS
KS200460470AMedicaid
11759335OtherCAQH
11759335OtherCAQH