Healthcare Provider Details

I. General information

NPI: 1619328176
Provider Name (Legal Business Name): PATRICK SEXTON M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3137 HENNEPIN AVE
MINNEAPOLIS MN
55408-2601
US

IV. Provider business mailing address

4941 UPTON AVE S
MINNEAPOLIS MN
55410-1809
US

V. Phone/Fax

Practice location:
  • Phone: 612-231-3660
  • Fax: 612-920-1911
Mailing address:
  • Phone: 612-920-1911
  • Fax: 612-920-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP3104
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: