Healthcare Provider Details

I. General information

NPI: 1023418274
Provider Name (Legal Business Name): PATRICIA CASTELLANOS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 W 143RD ST STE 102
SAVAGE MN
55378-2890
US

IV. Provider business mailing address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-1000
  • Fax:
Mailing address:
  • Phone: 612-873-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP5789
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: