Basic Information
| Provider Information | |||||||||
| NPI: | 1174560932 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLINDWORTH-ERICKSON | ||||||||
| FirstName: | LUANN | ||||||||
| MiddleName: | MARIEDA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 SILVER LAKE RD NW | ||||||||
| Address2: | |||||||||
| City: | NEW BRIGHTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551121786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516289566 | ||||||||
| FaxNumber: | 6516280411 | ||||||||
| Practice Location | |||||||||
| Address1: | 1811 WEIR DR STE 270 | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551256741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517149646 | ||||||||
| FaxNumber: | 6517149647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 05/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | LP4039 | MN | N | Behavioral Health & Social Service Providers | Psychologist | 103TM1800X | LP4039 | MN | N | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities | 103TC0700X | LP4039 | MN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.