Healthcare Provider Details

I. General information

NPI: 1679512586
Provider Name (Legal Business Name): PAULETTE VIRGINIA AASEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 W DIVIDE AVE SUITE 5
BISMARCK ND
58501
US

IV. Provider business mailing address

1237 W DIVIDE AVE SUITE 5
BISMARCK ND
58501-1220
US

V. Phone/Fax

Practice location:
  • Phone: 701-328-8863
  • Fax: 701-328-8900
Mailing address:
  • Phone: 701-328-8863
  • Fax: 701-328-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number381
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: