Provider Demographics
NPI:1649635418
Name:BAAS, STEPHANIE LEA (PSYD LP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEA
Last Name:BAAS
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:FREED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1406 6TH AVENUE NORTH
Mailing Address - Street 2:ST CLOUD HOSPITAL
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1901
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-656-7115
Practice Address - Street 1:1406 6TH AVENUE NORTH
Practice Address - Street 2:ST CLOUD HOSPITAL
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1901
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-656-7115
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5951103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist