Provider Demographics
NPI:1932275492
Name:WITT, PATRICIA ANN (RD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:WITT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:ZANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:STE 315
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-993-7169
Mailing Address - Fax:952-993-0300
Practice Address - Street 1:6465 WAYZATA BLVD
Practice Address - Street 2:STE 315
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1728
Practice Address - Country:US
Practice Address - Phone:952-993-7169
Practice Address - Fax:952-993-0300
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1418106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist