Provider Demographics
NPI:1619198843
Name:DETTLING, PATRICIA LYNN (LSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LYNN
Last Name:DETTLING
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HWY 2 W
Mailing Address - Street 2:LAKE REGION HUMAN SERVICE CENTER
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2418
Mailing Address - Country:US
Mailing Address - Phone:701-665-2200
Mailing Address - Fax:701-665-2300
Practice Address - Street 1:200 HWY 2 W
Practice Address - Street 2:LAKE REGION HUMAN SERVICE CENTER
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2418
Practice Address - Country:US
Practice Address - Phone:701-665-2200
Practice Address - Fax:701-665-2300
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3834104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker