Provider Demographics
NPI:1043195969
Name:DODGE, PATRICIA COLLINS (PPS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:COLLINS
Last Name:DODGE
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W LOMOND ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-9274
Mailing Address - Country:US
Mailing Address - Phone:831-338-6413
Mailing Address - Fax:
Practice Address - Street 1:400 W LOMOND ST
Practice Address - Street 2:
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-9274
Practice Address - Country:US
Practice Address - Phone:831-338-6413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool