Organization
ANDREA ANDERSON PSYD LP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA ANDERSON PSYD LP (LICENSED PSYCHOLOGIST)
(612) 963-7027
Entity
Organization
Contact information
Practice address
4660 SLATER RD STE 245-C, EAGAN, MN 55122-4047
(612) 963-7027
Mailing address
1826 WALNUT LN, EAGAN, MN 55122-2434
(612) 963-7027
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP5161
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659604874
—
MN
Enumeration date
12/12/2017
Last updated
12/12/2017
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