Provider Demographics
NPI:1730451923
Name:DANIEL LEGERSKI, PSY.D., LP, LLC
Entity type:Organization
Organization Name:DANIEL LEGERSKI, PSY.D., LP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:LEGERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:952-200-9804
Mailing Address - Street 1:5200 WILLSON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1332
Mailing Address - Country:US
Mailing Address - Phone:952-200-9804
Mailing Address - Fax:952-920-2461
Practice Address - Street 1:5200 WILLSON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1332
Practice Address - Country:US
Practice Address - Phone:952-200-9804
Practice Address - Fax:952-920-2461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4384103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN156798500Medicaid
MN156798500Medicaid