Provider Demographics
NPI:1508529165
Name:LEDUC, CHRISTY LYNNE (MA, MS, LAMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LYNNE
Last Name:LEDUC
Suffix:
Gender:F
Credentials:MA, MS, LAMFT
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:L
Other - Last Name:LEDUC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MS, LAMFT
Mailing Address - Street 1:2747 PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1346
Mailing Address - Country:US
Mailing Address - Phone:320-248-8004
Mailing Address - Fax:
Practice Address - Street 1:600 25TH AVE S STE 102
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4820
Practice Address - Country:US
Practice Address - Phone:320-406-1600
Practice Address - Fax:320-406-1700
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist