Provider Demographics
NPI:1447401286
Name:GERDIS, LYN BADJE (MSSW, LICSW)
Entity Type:Individual
Prefix:
First Name:LYN
Middle Name:BADJE
Last Name:GERDIS
Suffix:
Gender:F
Credentials:MSSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 UNIVERSITY AVE SE STE 400
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-4603
Mailing Address - Country:US
Mailing Address - Phone:612-874-6409
Mailing Address - Fax:612-874-0157
Practice Address - Street 1:2829 UNIVERSITY AVE SE STE 400
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-4603
Practice Address - Country:US
Practice Address - Phone:612-874-6409
Practice Address - Fax:612-874-0157
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN026781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical