Provider Demographics
NPI:1497904114
Name:STANKOVITCH, PATRICIA ANNE (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANNE
Last Name:STANKOVITCH
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 FORD PKWY
Mailing Address - Street 2:#200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1863
Mailing Address - Country:US
Mailing Address - Phone:651-739-6167
Mailing Address - Fax:
Practice Address - Street 1:2136 FORD PKWY
Practice Address - Street 2:#200
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1863
Practice Address - Country:US
Practice Address - Phone:651-739-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4947103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling