Provider Demographics
NPI:1750448049
Name:BAARDSON, STEVEN (MA LP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BAARDSON
Suffix:
Gender:M
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 LILAC DR N
Mailing Address - Street 2:STE 150
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4535
Mailing Address - Country:US
Mailing Address - Phone:763-544-8194
Mailing Address - Fax:763-544-4413
Practice Address - Street 1:1405 LILAC DR N
Practice Address - Street 2:STE 150
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4535
Practice Address - Country:US
Practice Address - Phone:763-544-8194
Practice Address - Fax:763-544-4413
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0258103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist