Provider Demographics
NPI:1386879799
Name:RODNING, PATRICK GORDON (MA LPCC)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:GORDON
Last Name:RODNING
Suffix:
Gender:M
Credentials:MA LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1992 STARLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-8607
Mailing Address - Country:US
Mailing Address - Phone:612-636-0136
Mailing Address - Fax:952-442-8607
Practice Address - Street 1:1992 STARLIGHT DR
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-8607
Practice Address - Country:US
Practice Address - Phone:612-636-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00010101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health