Provider Demographics
NPI:1922152966
Name:KUTZ, LINDA ANN (PSYD LP)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:KUTZ
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PRAIRIE CENTER DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7909
Mailing Address - Country:US
Mailing Address - Phone:952-944-1149
Mailing Address - Fax:
Practice Address - Street 1:250 PRAIRIE CENTER DR
Practice Address - Street 2:SUITE 270
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7909
Practice Address - Country:US
Practice Address - Phone:952-944-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4087103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist