Provider Demographics
NPI:1902999501
Name:AYD, JANETTE MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANETTE
Middle Name:MARIE
Last Name:AYD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 24TH AVE. SO.
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3024
Mailing Address - Country:US
Mailing Address - Phone:612-229-1234
Mailing Address - Fax:
Practice Address - Street 1:4004 24TH AVE. SO.
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3024
Practice Address - Country:US
Practice Address - Phone:612-229-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN301L9AYOtherBLUE CROSS BLUE SHIELD