Provider Demographics
NPI:1699897850
Name:MEYER, DUSTINE A (LP-3424)
Entity type:Individual
Prefix:MRS
First Name:DUSTINE
Middle Name:A
Last Name:MEYER
Suffix:
Gender:F
Credentials:LP-3424
Other - Prefix:
Other - First Name:DUSTINE
Other - Middle Name:ANNETTE
Other - Last Name:GETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AV.
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454
Mailing Address - Country:US
Mailing Address - Phone:612-273-5501
Mailing Address - Fax:612-273-3730
Practice Address - Street 1:2450 RIVERSIDE AV.
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-5501
Practice Address - Fax:612-273-3730
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3424103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist