MEDICARE: KATIE ANDERSON, PSYD, LP, LLC

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	251S00000X	Community/Behavioral Health Agency	LP5350	MN

General Provider Information

NPI Number	:	1598168700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATIE ANDERSON, PSYD, LP, LLC

Provider Business Mailing Address
First Line	:	3801 W 50TH ST
Second Line	:	#250A
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-2047
Country	:	US
Telephone Number	:	612-910-1890
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 W 50TH ST
Second Line	:	#250A
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-2047
Country	:	US
Telephone Number	:	612-910-1890
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. KATIE ANDERSON
Credential	:	PSYD
Telephone Number	:	612-910-1890

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	10/01/2014

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