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General NPI Number Information
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NPI Number | 1407971757
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Entity Type | Individual
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Provider Name | ANDRYA DIETER PSY.D, L.P.
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 3101 OLD HIGHWAY 8 # 304B
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City | ROSEVILLE
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State | MN
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Zip | 55113-1072
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Country | US
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Telephone | 763-478-1283
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Fax | 651-925-0304
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Provider Business Mailing Address
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Address Line | 3101 OLD HIGHWAY 8 # 304B
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City | ROSEVILLE
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State | MN
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Zip | 55113-1072
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Country | US
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Telephone | 763-478-1283
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Fax | 651-925-0304
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5360
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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