1790917920 NPI number — CONSTANCE LEE STUDER MA, LMFT

Table of content: CONSTANCE LEE STUDER MA, LMFT (NPI 1790917920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790917920 NPI number — CONSTANCE LEE STUDER MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUDER
Provider First Name:
CONSTANCE
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790917920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3137 HENNEPIN AVE S
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55408-2601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-275-1657
Provider Business Mailing Address Fax Number:
612-435-2378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3137 HENNEPIN AVE S
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55408-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-275-1657
Provider Business Practice Location Address Fax Number:
612-435-2378
Provider Enumeration Date:
08/21/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1760 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)