Provider Demographics
NPI:1215110861
Name:STUDER, PATRICIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:STUDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 S HILL AVE
Mailing Address - Street 2:A101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5751
Mailing Address - Country:US
Mailing Address - Phone:479-466-4503
Mailing Address - Fax:
Practice Address - Street 1:280 S HILL AVE
Practice Address - Street 2:A101
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5751
Practice Address - Country:US
Practice Address - Phone:479-466-4503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR07-35P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical