Doctor Name: | NANCY CARLSON |
NPI Number: | 1104899327 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD, LP |
License Number: | LP2070 |
Business Practice Address: | 11800 Singletree Ln #203 Eden Prairie, MN - 553445328 |
Business Phone Number: | 9529445502 |
Business Fax Number: | 9529417640 |
Mailing Address: | 9637 Anderson Lakes Pkwy, #162 EDEN PRAIRIE |
State: | MN |
Postal Code: | 553444155 |
Phone Number: | 9529445502 |
Fax Number: | 9529417640 |
NPI Enumeration Date: | 02/08/2006 |
NPI Last Update Date: | 03/31/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | LP2070 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |