Healthcare Provider Details

I. General information

NPI: 1275940967
Provider Name (Legal Business Name): PATRICK FOLEY LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

14335 WILSON DR
EDEN PRAIRIE MN
55347-4179
US

V. Phone/Fax

Practice location:
  • Phone: 612-629-7005
  • Fax:
Mailing address:
  • Phone: 612-355-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23424
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: