Basic Information
| Provider Information | |||||||||
| NPI: | 1780611830 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | DEANNA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | CENTER FOR SEXUAL HEALTH | ||||||||
| Address2: | 1300 2ND AVENUE SOUTH, SUITE 180 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126251500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CENTER FOR SEXUAL HEALTH | ||||||||
| Address2: | 1300 2ND AVENUE SOUTH, SUITE 180 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126251500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | LP4588 | MN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 61-94799 | 01 | MN | MEDICA CHOICE | OTHER | 1044539 | 01 | MN | PREFERRED ONE | OTHER | 664495300 | 05 | MN | MEDICAID | HP54842 | 01 | MN | HEALTHPARTNERS | OTHER |