Provider Demographics
NPI:1780611830
Name:CARPENTER, DEANNA LYNN (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:LYNN
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTER FOR SEXUAL HEALTH
Mailing Address - Street 2:1300 2ND AVENUE SOUTH, SUITE 180
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-1500
Mailing Address - Fax:
Practice Address - Street 1:CENTER FOR SEXUAL HEALTH
Practice Address - Street 2:1300 2ND AVENUE SOUTH, SUITE 180
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4588103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61-94799OtherMEDICA CHOICE
MN1044539OtherPREFERRED ONE
MN664495300Medicaid
MNHP54842OtherHEALTHPARTNERS