Basic Information
| Provider Information | |||||||||
| NPI: | 1609515089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINDEMAN | ||||||||
| FirstName: | MADDILYN | ||||||||
| MiddleName: | C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 STEWART AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551024117 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 280 SMITH AVE N STE 450 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512415959 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2022 | ||||||||
| LastUpdateDate: | 10/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | LP6795 | MN | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | LP6795 | MN | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.