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General NPI Number Information
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NPI Number | 1720593841
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Entity Type | Organization
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Legal Business Name | ANDREA ANDERSON PSYD LP LLC
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 4660 SLATER RD STE 245-C
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City | EAGAN
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State | MN
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Zip | 55122-4047
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Country | US
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Telephone | 612-963-7027
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Fax |
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Provider Business Mailing Address
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Address Line | 1826 WALNUT LN
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City | EAGAN
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State | MN
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Zip | 55122-2434
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Country | US
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Telephone | 612-963-7027
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | ANDREA ANDERSON
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Credential | PSYD LP
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Telephone | 612-963-7027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP5161
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License Number State | MN
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