Healthcare Provider Details

I. General information

NPI: 1972804870
Provider Name (Legal Business Name): THOMAS PAUL PATTERSON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 S HIGH AVE
AMES IA
50010-8055
US

IV. Provider business mailing address

1619 SOUTH HIGH AVENUE THE RICHMOND CENTER
AMES IA
50010
US

V. Phone/Fax

Practice location:
  • Phone: 515-232-5811
  • Fax: 515-232-3780
Mailing address:
  • Phone: 515-232-5811
  • Fax: 515-232-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number007617
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: