Individual
DR. LISA JOAN NIPPOLDT-BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, LP, ABPP
Contact information
Practice address
1937 WOODLANE DRIVE, SUITE 101, WOODBURY, MN 55125
(651) 764-8480
(651) 471-9253
Mailing address
1937 WOODLANE DRIVE, SUITE 101, WOODBURY, MN 55125
(651) 764-8480
(651) 471-9253
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
LP5271
MN
103T00000X
Psychologist
LP5271
MN
103TC0700X
Clinical Psychologist
LP5271
MN
Other
Enumeration date
10/23/2009
Last updated
04/25/2024
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