Provider Demographics
NPI:1760454870
Name:NOVAKOVICH, PATRICIA L (MA LP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:NOVAKOVICH
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Gender:F
Credentials:MA LP
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5463
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:2701 UNIVERSITY AVE SE
Practice Address - Street 2:MAIL STOP 32100A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3233
Practice Address - Country:US
Practice Address - Phone:612-627-3500
Practice Address - Fax:612-627-3535
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN3519103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical