Provider Demographics
NPI:1679512586
Name:AASEN, PAULETTE VIRGINIA (PHD)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:VIRGINIA
Last Name:AASEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 W DIVIDE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1220
Mailing Address - Country:US
Mailing Address - Phone:701-328-8863
Mailing Address - Fax:701-328-8900
Practice Address - Street 1:1237 W DIVIDE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-328-8863
Practice Address - Fax:701-328-8900
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND381103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN656T1AAOtherBCBS MN PROVIDER NUMBER
ND026006OtherBCBS ND PROVIDER NUMBER
ND054519Medicaid
ND026006OtherBCBS ND PROVIDER NUMBER