NPI | 1831574672 |
---|---|
Former Name | LAURI ANN WEICKERT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN cc00583) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303789) |
Enumeration Date | 2015-07-22 |
Last Update Date | 2022-12-23 |