Provider Demographics
NPI:1346704871
Name:PALADIE, PAUL L (MSW,LMSW, LICSW,LADC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:PALADIE
Suffix:
Gender:M
Credentials:MSW,LMSW, LICSW,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:MARINE ON SAINT CROIX
Mailing Address - State:MN
Mailing Address - Zip Code:55047-9601
Mailing Address - Country:US
Mailing Address - Phone:507-202-7196
Mailing Address - Fax:
Practice Address - Street 1:1715 TOWER DR W STE 100
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7609
Practice Address - Country:US
Practice Address - Phone:507-202-7196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305024101YA0400X
TX668171041C0700X
MN256841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)