Provider Demographics
NPI:1043618564
Name:BOETTGER, LINDSAY (MA, LPCC, ADC)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:BOETTGER
Suffix:
Gender:F
Credentials:MA, LPCC, ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MADISON AVE
Mailing Address - Street 2:SUITE 628
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5473
Mailing Address - Country:US
Mailing Address - Phone:507-779-7366
Mailing Address - Fax:507-779-7367
Practice Address - Street 1:1400 MADISON AVE
Practice Address - Street 2:SUITE 628
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5473
Practice Address - Country:US
Practice Address - Phone:507-779-7366
Practice Address - Fax:507-779-7367
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional