Provider Demographics
NPI:1801878426
Name:DAFFINRUD, STEVEN PETER (MA LP)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:PETER
Last Name:DAFFINRUD
Suffix:
Gender:M
Credentials:MA LP
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Mailing Address - Street 1:600 25TH AVE S
Mailing Address - Street 2:ROOSEVELT OFFICE PARK SUITE 109
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4841
Mailing Address - Country:US
Mailing Address - Phone:320-255-0343
Mailing Address - Fax:320-654-0318
Practice Address - Street 1:600 25TH AVE S
Practice Address - Street 2:ROOSEVELT OFFICE PARK SUITE 109
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4841
Practice Address - Country:US
Practice Address - Phone:320-255-0343
Practice Address - Fax:320-654-0318
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP3707103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3041301OtherBHP
625T442OtherUBH
S01906459OtherMMSI
MN7144245Medicaid
MN314K4DAOtherBCBS BLUE PLUS COMPCARE
MN116812OtherU CARE