=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548370190
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHANNA LEE LAMM PSY.D, L.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11812 WAYZATA BLVD SUITE 212
-----------------------------------------------------
City | MINNETONKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55305-2012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-708-8100
-----------------------------------------------------
Fax | 612-337-7638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10640 48TH AVE N
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55442-2560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-553-4008
-----------------------------------------------------
Fax | 612-337-7638
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | LP 4568
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------