Provider Demographics
NPI:1376995936
Name:DAIGLE, ROSAIRE PATRICK (PHD)
Entity Type:Individual
Prefix:
First Name:ROSAIRE
Middle Name:PATRICK
Last Name:DAIGLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 HAMLINE AVE N STE 611
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5007
Mailing Address - Country:US
Mailing Address - Phone:612-268-0822
Mailing Address - Fax:651-502-2179
Practice Address - Street 1:2233 HAMLINE AVE N STE 611
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5007
Practice Address - Country:US
Practice Address - Phone:612-268-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6226103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist