Provider Demographics
NPI:1497096374
Name:WHELAN, PATRICIA LEE ANN
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE ANN
Last Name:WHELAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 JAY ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-1453
Mailing Address - Country:US
Mailing Address - Phone:218-340-5532
Mailing Address - Fax:
Practice Address - Street 1:1402 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2430
Practice Address - Country:US
Practice Address - Phone:218-728-7922
Practice Address - Fax:218-728-7923
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-02
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN181961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical