Individual
DR. LINDA RAE DETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D., L.P.
Contact information
Practice address
2215 E LAKE ST, MINNEAPOLIS, MN 55407-4385
(612) 596-9438
Mailing address
2215 E LAKE ST, MINNEAPOLIS, MN 55407-4385
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
3096-57
WI
103T00000X
Psychologist
LP 5597
MN
103T00000X
Psychologist
Primary
LP5597
MN
103TC0700X
Clinical Psychologist
3096-57
WI
103TC0700X
Clinical Psychologist
LP 5597
MN
103TC2200X
Clinical Child & Adolescent Psychologist
3096-57
WI
103TC2200X
Clinical Child & Adolescent Psychologist
LP-5597
MN
Other
Enumeration date
03/13/2013
Last updated
08/31/2022
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