Healthcare Provider Details

I. General information

NPI: 1568597573
Provider Name (Legal Business Name): PATRICIA LYNN CROWNS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 EDGERTON ST
LITTLE CANADA MN
55117-1620
US

IV. Provider business mailing address

1700 HIGHWAY 36 W 516 ROSEDALE TOWERS
ROSEVILLE MN
55113-4034
US

V. Phone/Fax

Practice location:
  • Phone: 651-484-1544
  • Fax:
Mailing address:
  • Phone: 612-728-8901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4141
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: