Provider Demographics
NPI:1750435178
Name:LINDBERG, PATRICIA SUSAN (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SUSAN
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23055 HAYWARD AVE N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-8542
Mailing Address - Country:US
Mailing Address - Phone:651-464-2423
Mailing Address - Fax:
Practice Address - Street 1:614 PORTLAND AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2223
Practice Address - Country:US
Practice Address - Phone:651-291-2720
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
MNLP2694103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist