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Individual

LISA R HARDESTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
1695 LOR RAY DR, NORTH MANKATO, MN 56003-2804
(507) 387-8231
Mailing address
1025 MARSH ST, MANKATO, MN 56001-4752
(507) 625-4031

Taxonomy

Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
3904
MN
103TC0700X
Clinical Psychologist
Primary
LP3904
MN

Other

Enumeration date
12/02/2005
Last updated
09/18/2020
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