MEDICARE: CYNTHIA CRANDALL PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	LP4201	MN

General Provider Information

NPI Number	:	1023030418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA CRANDALL PSY.D

Provider Business Mailing Address
First Line	:	3133 HENNEPIN AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2620
Country	:	US
Telephone Number	:	612-803-7368
Fax Number	:	612-823-3161

Provider Business Practice Location Address
First Line	:	3133 HENNEPIN AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2620
Country	:	US
Telephone Number	:	612-803-7368
Fax Number	:	612-823-3161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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