Provider Demographics
NPI:1407971757
Name:DIETER, ANDRYA (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:ANDRYA
Middle Name:
Last Name:DIETER
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:ANDRYA
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LP
Mailing Address - Street 1:3101 OLD HIGHWAY 8 # 304B
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1072
Mailing Address - Country:US
Mailing Address - Phone:763-478-1283
Mailing Address - Fax:651-925-0304
Practice Address - Street 1:3101 OLD HIGHWAY 8 # 304B
Practice Address - Street 2:
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:651-925-0304
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5360103T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health