Provider Demographics
NPI:1598168700
Name:KATIE ANDERSON, PSYD, LP, LLC
Entity Type:Organization
Organization Name:KATIE ANDERSON, PSYD, LP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:612-910-1890
Mailing Address - Street 1:3801 W 50TH ST
Mailing Address - Street 2:#250A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2047
Mailing Address - Country:US
Mailing Address - Phone:612-910-1890
Mailing Address - Fax:
Practice Address - Street 1:3801 W 50TH ST
Practice Address - Street 2:#250A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-2047
Practice Address - Country:US
Practice Address - Phone:612-910-1890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5350251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health