Provider Demographics
NPI:1316012867
Name:WHITNEY, LAURA ANN (LP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E 2ND ST
Mailing Address - Street 2:ESSENTIA HEALTH POLINSKY MEDICAL REHAB CENTER
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1913
Mailing Address - Country:US
Mailing Address - Phone:218-786-5360
Mailing Address - Fax:
Practice Address - Street 1:530 E 2ND ST
Practice Address - Street 2:ESSENTIA HEALTH POLINSKY MEDICAL REHAB CENTER
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1913
Practice Address - Country:US
Practice Address - Phone:218-786-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 3078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8753229-00Medicaid