Provider Demographics
NPI:1396768966
Name:VENEKAMP, PATTI ANN
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:ANN
Last Name:VENEKAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 LAKE ST S STE 102
Mailing Address - Street 2:
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347-7122
Mailing Address - Country:US
Mailing Address - Phone:320-732-7111
Mailing Address - Fax:
Practice Address - Street 1:221 LAKE ST S STE 102
Practice Address - Street 2:
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-7122
Practice Address - Country:US
Practice Address - Phone:320-732-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2812103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN543P1VEOtherBCBS
MN126424OtherUCARE
MN6269566OtherUBH MEDICA
MN116682OtherHEALTH PARTNERS