Provider Demographics
NPI:1083163745
Name:ANDRYA DIETER, PSYD, LP, LLC
Entity Type:Organization
Organization Name:ANDRYA DIETER, PSYD, LP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:763-478-1283
Mailing Address - Street 1:5219 JEFFERY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-4950
Mailing Address - Country:US
Mailing Address - Phone:763-478-1283
Mailing Address - Fax:651-925-0304
Practice Address - Street 1:3101 OLD HIGHWAY 8
Practice Address - Street 2:SUITE 304B
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1072
Practice Address - Country:US
Practice Address - Phone:763-478-1283
Practice Address - Fax:651-952-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5360251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health