Provider Demographics
NPI:1730194184
Name:NODLAND, LYNN WORKMAN (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:WORKMAN
Last Name:NODLAND
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 EXCELSIOR BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-1981
Mailing Address - Country:US
Mailing Address - Phone:952-452-2664
Mailing Address - Fax:952-401-0480
Practice Address - Street 1:684 EXCELSIOR BLVD
Practice Address - Street 2:SUITE NUMBER 120
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-1980
Practice Address - Country:US
Practice Address - Phone:952-452-2664
Practice Address - Fax:952-401-0480
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2607103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN66794NOOtherBLUECROSS BLUESHIELD MN