Provider Demographics
NPI:1609886407
Name:SHIELDS, PATRICK EDWARD (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:EDWARD
Last Name:SHIELDS
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 1:1940 GREELEY ST S
Mailing Address - Street 2:202A
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5097
Mailing Address - Country:US
Mailing Address - Phone:651-275-1307
Mailing Address - Fax:651-433-4531
Practice Address - Street 1:1940 GREELEY ST S
Practice Address - Street 2:202A
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5097
Practice Address - Country:US
Practice Address - Phone:651-275-1307
Practice Address - Fax:651-433-4531
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical