Provider Demographics
NPI:1346040458
Name:ANDERSON, LYDIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 FRIBERG AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2306
Mailing Address - Country:US
Mailing Address - Phone:218-693-3508
Mailing Address - Fax:218-332-2019
Practice Address - Street 1:119 FRIBERG AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2306
Practice Address - Country:US
Practice Address - Phone:218-693-3508
Practice Address - Fax:218-332-2019
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional