Healthcare Provider Details

I. General information

NPI: 1063054476
Provider Name (Legal Business Name): JULIE ANNE PATTEN PSY. D., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 6TH ST SE
WILLMAR MN
56201-4675
US

IV. Provider business mailing address

114 N HOLCOMBE AVE # 230
LITCHFIELD MN
55355-2210
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-4613
  • Fax: 855-625-7406
Mailing address:
  • Phone: 320-693-7221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP6459
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: