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General NPI Number Information
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NPI Number | 1396040911
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Entity Type | Organization
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Legal Business Name | BAGDADE AND ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 2945 HAZELWOOD ST STE 200
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1243
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Country | US
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Telephone | 612-440-6315
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Fax | 651-412-5338
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Provider Business Mailing Address
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Address Line | 2945 HAZELWOOD ST STE 200
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1243
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Country | US
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Telephone | 612-440-6315
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Fax | 651-412-5338
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/PRINCIPAL OWN
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Name | DR. PAUL STEVEN BAGDADE
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Credential | PH.D.
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Telephone | 612-440-6315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP4527
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License Number State | MN
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