Provider Demographics
NPI:1700356268
Name:PATRIDGE, ADRIENNE RAE (MS, LPC)
Entity Type:Individual
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First Name:ADRIENNE
Middle Name:RAE
Last Name:PATRIDGE
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Gender:F
Credentials:MS, LPC
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1312 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-2323
Mailing Address - Country:US
Mailing Address - Phone:208-919-9555
Mailing Address - Fax:208-336-7125
Practice Address - Street 1:1408 W HAYS ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5028
Practice Address - Country:US
Practice Address - Phone:208-919-9555
Practice Address - Fax:208-336-7125
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health