Provider Demographics
NPI:1508066929
Name:LARDY, JOHN STEVEN (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STEVEN
Last Name:LARDY
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
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Mailing Address - Street 1:5836 ABBOTT AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2810
Mailing Address - Country:US
Mailing Address - Phone:952-848-1722
Mailing Address - Fax:952-996-2058
Practice Address - Street 1:13750 CROSSTOWN DR NW STE 310
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-5853
Practice Address - Country:US
Practice Address - Phone:763-482-9598
Practice Address - Fax:763-482-9598
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN40791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4079OtherMINNESOTA BOARD OF SOCIAL