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General NPI Number Information
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NPI Number | 1982689592
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Entity Type | Individual
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Provider Name | MARYANNE ANNE LASSEGARD PH.D LP
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Gender | Female
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Dates
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Enumeration Date | 12/07/2005
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 521 TANGLEWOOD DR
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City | SHOREVIEW
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State | MN
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Zip | 55126-2016
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Country | US
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Telephone | 612-306-4721
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Fax | 763-434-6570
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Provider Business Mailing Address
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Address Line | 3340 INTERLACHEN DR NE
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City | HAM LAKE
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State | MN
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Zip | 55304-4507
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Country | US
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Telephone | 763-434-6570
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Fax | 763-434-6570
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LP2187
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | LP2187
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | LP2187
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP2187
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LP2187
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License Number State | MN
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Taxonomy #6
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | LP2187
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License Number State | MN
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Taxonomy #7
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | LP2187
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License Number State | MN
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Taxonomy #8
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | LP2187
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License Number State | MN
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Taxonomy #9
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP2187
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License Number State | MN
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