Provider Demographics
NPI:1033436167
Name:BECKWITH, LORI MARIE CARGEN (LADC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:MARIE CARGEN
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:M
Other - Last Name:CARGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:11400 JULIANNE AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-9436
Mailing Address - Country:US
Mailing Address - Phone:612-454-2406
Mailing Address - Fax:651-426-0419
Practice Address - Street 1:11400 JULIANNE AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-9436
Practice Address - Country:US
Practice Address - Phone:612-454-2406
Practice Address - Fax:651-426-0419
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302856101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)