Provider Demographics
NPI:1912051780
Name:RIDGE, THOMAS AARON (MS,LP,LICSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:AARON
Last Name:RIDGE
Suffix:
Gender:M
Credentials:MS,LP,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 5TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1301
Mailing Address - Country:US
Mailing Address - Phone:612-379-8750
Mailing Address - Fax:612-378-6025
Practice Address - Street 1:1135 5TH ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1301
Practice Address - Country:US
Practice Address - Phone:612-379-8750
Practice Address - Fax:612-378-6025
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist