| Doctor Name: | LISA R HARDESTY |
| NPI Number: | 1154305126 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 3904 |
| Business Practice Address: | 1695 Lor Ray Dr North Mankato, MN - 560032804 |
| Business Phone Number: | 5073878231 |
| Business Fax Number: | |
| Mailing Address: | 1025 Marsh St, MANKATO |
| State: | MN |
| Postal Code: | 560014752 |
| Phone Number: | 5076254031 |
| Fax Number: | |
| NPI Enumeration Date: | 12/02/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | 3904 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |