Provider Demographics
NPI:1982714051
Name:MOSING, PATRICIA ROSE (PHD, LP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ROSE
Last Name:MOSING
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3702
Mailing Address - Country:US
Mailing Address - Phone:612-827-2436
Mailing Address - Fax:612-823-4856
Practice Address - Street 1:3249 HENNEPIN AVE. #258
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3993
Practice Address - Country:US
Practice Address - Phone:612-272-2587
Practice Address - Fax:612-236-4292
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3473103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN430G7MOOtherBLUECROSSBLUESHIELDIND.
MN838720600Medicaid