Provider Demographics
NPI:1285793067
Name:SPRINGSTEAD, PAUL STEVEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEVEN
Last Name:SPRINGSTEAD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14635 SPRINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-6010
Mailing Address - Country:US
Mailing Address - Phone:218-855-1855
Mailing Address - Fax:
Practice Address - Street 1:1906 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3317
Practice Address - Country:US
Practice Address - Phone:320-632-6647
Practice Address - Fax:320-632-9525
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1296103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR04818Medicare UPIN