Basic Information
| Provider Information | |||||||||
| NPI: | 1497096374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHELAN | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | LEE ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4120 JAY ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558041453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183405532 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1402 E SUPERIOR ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187287922 | ||||||||
| FaxNumber: | 2187287923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2013 | ||||||||
| LastUpdateDate: | 03/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 18196 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.