Provider Demographics
NPI:1811069743
Name:SCHOLDER, LISA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:SCHOLDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 TWELVE OAKS CENTER DR
Mailing Address - Street 2:SUITE 926E
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-4701
Mailing Address - Country:US
Mailing Address - Phone:612-300-2440
Mailing Address - Fax:
Practice Address - Street 1:901 TWELVE OAKS CENTER DR
Practice Address - Street 2:SUITE 926E
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4701
Practice Address - Country:US
Practice Address - Phone:612-300-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3972101YM0800X
MNLP 3972103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61-39432OtherMEDICA
MN166600200Medicaid
MN6800001758Medicare ID - Type Unspecified
MN160420OtherUCARE
MN61B92SCOtherBLUECROSSBLUESHIELD
MNHP35174OtherHEALTHPARTNERS