Provider Demographics
NPI:1255343406
Name:NELSON, LINDA KATHLEEN (MS, LP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:KATHLEEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, LP
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:KATHLEEN
Other - Last Name:MOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,LP, CCMHC
Mailing Address - Street 1:1113 290TH ST
Mailing Address - Street 2:
Mailing Address - City:HENDRICKS
Mailing Address - State:MN
Mailing Address - Zip Code:56136-4000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1212 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2010
Practice Address - Country:US
Practice Address - Phone:507-532-3236
Practice Address - Fax:507-532-0240
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3517103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1396793OtherUNITED HEALTH CARE
MN21537OtherSIOUX VALLEY HEALTH
MNHP37853OtherHEALTH PARTNERS
MN105031OtherUCARE
MN1011832OtherPREFERRED ONE
MN38T69NEOtherBLUE CROSS BLUE SHIELD