Individual
LYNNE M STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
4300 EDGEWOOD DR NE, SAINT MICHAEL, MN 55376-4588
(763) 744-4000
(763) 744-4124
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-4813
(612) 262-4194
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4222
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
670914100
—
MN
Enumeration date
05/08/2006
Last updated
03/11/2021
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