Healthcare Provider Details

I. General information

NPI: 1922152966
Provider Name (Legal Business Name): LINDA ANN KUTZ PSY.D. LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PRAIRIE CENTER DR SUITE 270
EDEN PRAIRIE MN
55344-7909
US

IV. Provider business mailing address

250 PRAIRIE CENTER DR SUITE 270
EDEN PRAIRIE MN
55344-7909
US

V. Phone/Fax

Practice location:
  • Phone: 952-944-1149
  • Fax:
Mailing address:
  • Phone: 952-944-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4087
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: