Individual
DR. MARYANNE ANNE LASSEGARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D LP
Contact information
Practice address
521 TANGLEWOOD DR, SHOREVIEW, MN 55126-2016
(612) 306-4721
(763) 434-6570
Mailing address
3340 INTERLACHEN DR NE, HAM LAKE, MN 55304-4507
(763) 434-6570
(763) 434-6570
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LP2187
MN
103T00000X
Psychologist
LP2187
MN
103TA0700X
Adult Development & Aging Psychologist
LP2187
MN
103TB0200X
Cognitive & Behavioral Psychologist
LP2187
MN
103TC0700X
Clinical Psychologist
Primary
LP2187
MN
103TC1900X
Counseling Psychologist
LP2187
MN
103TF0000X
Family Psychologist
LP2187
MN
103TH0100X
Health Service Psychologist
LP2187
MN
103TP2701X
Group Psychotherapy Psychologist
LP2187
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031016600
—
MN
01
—
08S11LU
BCBS
FM
01
—
57610
CIGNA
MN
01
—
6124240
MEDICA
FM
01
—
854806
ARAZ
MN
Enumeration date
12/07/2005
Last updated
02/10/2017
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