Organization
ANDREA ANDERSON PSYD LP LLC
Active
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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