Individual
PATRICK JOHN DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.
Contact information
Practice address
366 PRIOR AVE N, SUITE 204, SAINT PAUL, MN 55104-5165
(651) 646-9638
Mailing address
366 PRIOR AVE N, SUITE 204, SAINT PAUL, MN 55104-5165
(651) 646-9638
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP 1483
MN
Other
Enumeration date
01/09/2008
Last updated
01/09/2008
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