Dr Maryanne Anne Lassegard, PHD LP is a medicare enrolled "Psychologist - Clinical" provider in Shoreview, Minnesota. Her current practice location is
521 Tanglewood Dr, Shoreview, Minnesota. You can reach out to her office (for appointments etc.) via phone at
(612) 306-4721.
Dr Maryanne Anne Lassegard is licensed to practice in Minnesota (license number LP2187) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1982689592.
Healthcare Provider's Profile
| Full Name | Dr Maryanne Anne Lassegard |
|---|
| Gender | Female |
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| Speciality | Psychologist - Clinical |
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| Location | 521 Tanglewood Dr, Shoreview, Minnesota |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1982689592
- Provider Enumeration Date: 12/07/2005
- Last Update Date: 02/10/2017
Medicare PECOS Information:
- PECOS PAC ID: 1658319272
- Enrollment ID: I20111108000740
Medical Identifiers
Medical identifiers for Dr Maryanne Anne Lassegard such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1982689592 | NPI | - | NPPES |
| 854806 | Other | MN | ARAZ |
| 08S11LU | Other | FM | BCBS |
| 031016600 | Medicaid | MN | |
| 57610 | Other | MN | CIGNA |
| 6124240 | Other | FM | MEDICA |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | LP2187 (Minnesota) | Secondary |
| 103TA0700X | Psychologist - Adult Development & Aging | LP2187 (Minnesota) | Secondary |
| 103TB0200X | Psychologist - Cognitive & Behavioral | LP2187 (Minnesota) | Secondary |
| 103TC0700X | Psychologist - Clinical | LP2187 (Minnesota) | Primary |
| 103TC1900X | Psychologist - Counseling | LP2187 (Minnesota) | Secondary |
| 103TF0000X | Psychologist - Family | LP2187 (Minnesota) | Secondary |
| 103TH0100X | Psychologist - Health Service | LP2187 (Minnesota) | Secondary |
| 103TP2701X | Psychologist - Group Psychotherapy | LP2187 (Minnesota) | Secondary |
| 103T00000X | Psychologist | LP2187 (Minnesota) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Maryanne Anne Lassegard is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Maryanne Anne Lassegard, PHD LP
3340 Interlachen Dr Ne,
Ham Lake, MN 55304-4507
Ph: (763) 434-6570 | Dr Maryanne Anne Lassegard, PHD LP
521 Tanglewood Dr,
Shoreview, MN 55126-2016
Ph: (612) 306-4721 |
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