Individual
ALYSSA CATHERINE TIEDENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC
Contact information
Practice address
9177 OAKVIEW LN N, MAPLE GROVE, MN 55369-6505
(763) 232-6394
Mailing address
501 OLD TOWN DRIVE, NEW BRIGHTON, MN 55112
(763) 232-6394
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2859
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000014006
BOARD OF CERTIFICATION
—
Enumeration date
01/09/2017
Last updated
04/25/2017
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