Provider Demographics
NPI:1548370190
Name:LAMM, JOHANNA LEE (PSYD, LP)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:LEE
Last Name:LAMM
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10640 48TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2560
Mailing Address - Country:US
Mailing Address - Phone:763-553-4008
Mailing Address - Fax:612-337-7638
Practice Address - Street 1:11812 WAYZATA BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2012
Practice Address - Country:US
Practice Address - Phone:612-708-8100
Practice Address - Fax:612-337-7638
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4568103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN82942337-00OtherUNITED BEHAVIORAL HEALTH
MN311S8LAOtherBLUE CROSS BLUE SHIELD
MNHP52699OtherHEALTHPARTNERS