Provider Demographics
NPI:1669658696
Name:HEDIGER, PATRICIA OVEDIA (LADC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:OVEDIA
Last Name:HEDIGER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
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Mailing Address - Street 1:1911 PLEASANT AVE SOUTH
Mailing Address - Street 2:CREATE, INC
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403
Mailing Address - Country:US
Mailing Address - Phone:612-874-9811
Mailing Address - Fax:612-874-9820
Practice Address - Street 1:1145 SHENANDOAH LANE
Practice Address - Street 2:ADULT CORRECTION FACILITY, TELESIS
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447
Practice Address - Country:US
Practice Address - Phone:612-596-0106
Practice Address - Fax:763-475-4297
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN301035101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN301035OtherLADC