Provider Demographics
NPI:1699816231
Name:ROBERT G PATTERSON LLC
Entity Type:Organization
Organization Name:ROBERT G PATTERSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-225-3622
Mailing Address - Street 1:405 8TH AVE NW
Mailing Address - Street 2:SUITE 333
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2762
Mailing Address - Country:US
Mailing Address - Phone:605-225-3622
Mailing Address - Fax:605-229-2719
Practice Address - Street 1:405 8TH AVE NW
Practice Address - Street 2:SUITE 333
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2762
Practice Address - Country:US
Practice Address - Phone:605-225-3622
Practice Address - Fax:605-229-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD149103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4993775OtherBCBS
SD6550013Medicaid