Provider Demographics
NPI:1891835229
Name:PRATT, CYNTHIA RUTH (MA, LP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RUTH
Last Name:PRATT
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6668
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-0668
Mailing Address - Country:US
Mailing Address - Phone:612-721-6886
Mailing Address - Fax:612-721-2832
Practice Address - Street 1:821 RAYMOND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1503
Practice Address - Country:US
Practice Address - Phone:612-721-6886
Practice Address - Fax:612-721-2832
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3495103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN060T7NOOtherBLUE CROSS BLUE SHILD