Healthcare Provider Details

I. General information

NPI: 1962414631
Provider Name (Legal Business Name): HAROLD DALE PATTERSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST
BOISE ID
83702-4501
US

IV. Provider business mailing address

680 AVENUE H APT 304
BOISE ID
83712-6468
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1145
  • Fax: 208-422-1241
Mailing address:
  • Phone: 208-344-3248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1295
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1295
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: