Provider Demographics
NPI:1639162407
Name:HARDY, LYNN D (MA, LP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:D
Last Name:HARDY
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:D
Other - Last Name:WHITING HARDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LP
Mailing Address - Street 1:11070 183RD CIR NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2842
Mailing Address - Country:US
Mailing Address - Phone:763-633-5111
Mailing Address - Fax:763-633-5112
Practice Address - Street 1:11070 183RD CIR NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2842
Practice Address - Country:US
Practice Address - Phone:763-633-5111
Practice Address - Fax:763-633-5112
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3938103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN640721800Medicaid