Healthcare Provider Details

I. General information

NPI: 1306918404
Provider Name (Legal Business Name): LEANN KAYE HUTTON PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 WILLOW ST SUITE 400
MINNEAPOLIS MN
55403-2269
US

IV. Provider business mailing address

1409 WILLOW ST SUITE 400
MINNEAPOLIS MN
55403-2269
US

V. Phone/Fax

Practice location:
  • Phone: 612-872-1500
  • Fax: 612-872-2205
Mailing address:
  • Phone: 612-872-1500
  • Fax: 612-872-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4840
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: