Provider Demographics
NPI:1700360963
Name:STANDERWICK, LYNDSIE A (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:LYNDSIE
Middle Name:A
Last Name:STANDERWICK
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5666 LINCOLN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1673
Mailing Address - Country:US
Mailing Address - Phone:612-361-2247
Mailing Address - Fax:
Practice Address - Street 1:5666 LINCOLN DR STE 101
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-1673
Practice Address - Country:US
Practice Address - Phone:612-361-2247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-23
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN3679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health