Provider Demographics
NPI:1073915435
Name:LORI PEIFFER, PHD, LP, LLC
Entity Type:Organization
Organization Name:LORI PEIFFER, PHD, LP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:C
Authorized Official - Last Name:PEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:612-584-8704
Mailing Address - Street 1:1800 WOODDALE DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:612-584-8704
Mailing Address - Fax:844-252-4852
Practice Address - Street 1:1800 WOODDALE DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:612-584-8704
Practice Address - Fax:844-252-4852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1962574376Medicare UPIN