Provider Demographics
NPI:1497888903
Name:RICHARDSON, PATRICIA ANN (MSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 DIVISION ST S
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2095
Mailing Address - Country:US
Mailing Address - Phone:507-645-5644
Mailing Address - Fax:
Practice Address - Street 1:401 DIVISION ST S
Practice Address - Street 2:SUITE C
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2095
Practice Address - Country:US
Practice Address - Phone:507-645-5644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN021791041C0700X
MN0154106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6220276OtherUNITED BEHAVIORAL HEALTH
MN8682OtherHEALTHPARTNERS
MN116174OtherUCARE
MN1A908RIOtherBLUE CROSS BLUE SHIELD OF
MN971857500Medicaid
MN971857500Medicaid