Healthcare Provider Details

I. General information

NPI: 1710016043
Provider Name (Legal Business Name): PATRICIA J. MACTAGGERT M.A.,L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA J STERNAU MA, LP

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LOST LAKE CT
MOUND MN
55364-4512
US

IV. Provider business mailing address

2301 LOST LAKE CT
MOUND MN
55364-4512
US

V. Phone/Fax

Practice location:
  • Phone: 612-803-2533
  • Fax:
Mailing address:
  • Phone: 612-803-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP2278
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: