Provider Demographics
NPI:1407938723
Name:ANDERSON, DEBORAH LYNNE (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LYNNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GROVELAND TER
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1154
Mailing Address - Country:US
Mailing Address - Phone:612-374-2400
Mailing Address - Fax:612-374-2401
Practice Address - Street 1:15 GROVELAND TER
Practice Address - Street 2:SUITE 302
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1154
Practice Address - Country:US
Practice Address - Phone:612-374-2400
Practice Address - Fax:612-374-2401
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4563103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61-90438OtherMEDICA
MN34008ANOtherBLUE CROSS BLUE SHIELD
MN119099OtherHEALTH PARTNERS
MN7903877OtherAETNA