Healthcare Provider Details

I. General information

NPI: 1891249140
Provider Name (Legal Business Name): KIMBERLY ANDERSON PSY.D., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 SILVER LAKE RD NW STE 2
NEW BRIGHTON MN
55112-9308
US

IV. Provider business mailing address

1403 SILVER LAKE RD NW STE 2
NEW BRIGHTON MN
55112-9308
US

V. Phone/Fax

Practice location:
  • Phone: 651-895-3624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6495
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: