Lisa Marie Anderson, PHD
Individual provider Active NPI Clinical Psychologist · St Louis Park, MN
NPI 1114504123 · NPPES record last updated Mar 25, 2021
Key facts
- NPI
- 1114504123
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- LP6534 (MN)
- Practice address
- 5775 Wayzata Blvd Ste 255
St Louis Park, MN 55416-1275 - Phone
- (952) 525-4500
- NPI assigned
- Mar 25, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210504000173 | MN | Practitioner - Clinical Psychologist | 6406265495 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Minnesota Physicians | Current |
Accepting new patients | |
| University of Minnesota Health Clinics and Surgery Center Inc | Current |
Accepting new patients | |
| University of Minnesota Physicians | Current | Accepting new patients | |
| University of Minnesota Health Clinics and Surgery Center, Inc. | Current |
Accepting new patients | |
| Fairview Express Care | Current |
Accepting new patients | |
| Fairview Express Care | Current |
Accepting new patients | |
| Fairview Express Care | Current | Accepting new patients | |
| University of Minnesota Physicians | Current |
Accepting new patients |
Locations
720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0769
909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383
2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838
720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649
717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617
516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600
5775 Wayzata Blvd
Ste 255
St Louis Park, MN 55416
Phone (612) 273-8710
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP6534 | MN | Yes |
Addresses
Primary practice location
5775 Wayzata Blvd Ste 255
St Louis Park, MN 55416-1275
Mailing address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Other providers in St Louis Park, MN
- Emily Anderson
- Floyd Owen Anderson
- Heidi M Anderson
- Holly N Anderson
- Jennifer Jane Anderson
- Lori Surma Anderson
- Lucinda Jo Anderson
- Mindy Anderson
- Molly Ann Anderson
- Paul Joseph Anderson II
All providers in St Louis Park, MN · Clinical Psychologist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.