Provider Demographics
NPI:1851013494
Name:DICKHUDT, ROBERT PAUL (LADC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:DICKHUDT
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-0379
Mailing Address - Country:US
Mailing Address - Phone:507-454-2270
Mailing Address - Fax:507-457-3027
Practice Address - Street 1:111 MARKET ST STE 2
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5532
Practice Address - Country:US
Practice Address - Phone:507-454-2270
Practice Address - Fax:507-457-3027
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304127101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)