Individual
PATRICK J. CARROLL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
214 4TH ST SW, WILLMAR, MN 56201-3330
(320) 235-6958
Mailing address
1525 15TH AVE SW, WILLMAR, MN 56201-2883
(320) 235-6958
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP 1747
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45119CA
BLUE CROSS BLUE SHIELD
—
Enumeration date
04/20/2006
Last updated
07/09/2007
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