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General NPI Number Information
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NPI Number | 1972839850
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Entity Type | Individual
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Provider Name | LISA ANN TATTAR PSY.D., LP
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Gender | Female
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 3450 O'LEARY LANE
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City | EAGAN
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State | MN
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Zip | 55123-2340
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Country | US
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Telephone | 651-365-8247
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Fax |
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Provider Business Mailing Address
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Address Line | 4144 BEAVER DAM ROAD
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City | EAGAN
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State | MN
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Zip | 55122-2123
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Country | US
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Telephone |
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5131
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License Number State | MN
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