Provider Demographics
NPI:1659033066
Name:CHRISTIANSON, LYDIA ANN (PSYD LP)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:ANN
Last Name:CHRISTIANSON
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 1:7582 CURRELL BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2471
Mailing Address - Country:US
Mailing Address - Phone:651-739-7539
Mailing Address - Fax:
Practice Address - Street 1:7582 CURRELL BLVD STE 208
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2471
Practice Address - Country:US
Practice Address - Phone:651-739-7539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MNLP7067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program