Provider Demographics
NPI:1699050179
Name:TIERNEY, ANNA LEIGH
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:LEIGH
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 PARKDALE DR
Mailing Address - Street 2:#2
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1603
Mailing Address - Country:US
Mailing Address - Phone:651-645-5323
Mailing Address - Fax:925-746-5962
Practice Address - Street 1:5354 PARKDALE DR
Practice Address - Street 2:#2
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1603
Practice Address - Country:US
Practice Address - Phone:651-645-5323
Practice Address - Fax:952-746-5962
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011004602103TC0700X
MNLP5538103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical