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NPI Code Detail

MEDICARE: BAGDADE AND ASSOCIATES, LLC

MEDICARE: BAGDADE AND ASSOCIATES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistLP4527MN

General Provider Information

NPI Number : 1396040911
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAGDADE AND ASSOCIATES, LLC
Provider Business Mailing Address
First Line : 2945 HAZELWOOD ST STE 200
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-1243
Country : US
Telephone Number : 612-440-6315
Fax Number : 651-412-5338
Provider Business Practice Location Address
First Line : 2945 HAZELWOOD ST STE 200
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-1243
Country : US
Telephone Number : 612-440-6315
Fax Number : 651-412-5338
Authorized Official
Title or Position : LICENSED PSYCHOLOGIST/PRINCIPAL OWN
Name : DR. PAUL STEVEN BAGDADE
Credential : PH.D.
Telephone Number : 612-440-6315
Provider Enumeration Date : 01/12/2011
Last Update Date : 05/14/2025

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