Provider Demographics
NPI:1376889873
Name:YLVISAKER, LOIS ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:ANN
Last Name:YLVISAKER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 11TH AVE NW STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2297
Mailing Address - Country:US
Mailing Address - Phone:507-292-1379
Mailing Address - Fax:507-289-4524
Practice Address - Street 1:602 11TH AVE NW STE 300
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2297
Practice Address - Country:US
Practice Address - Phone:507-292-1379
Practice Address - Fax:507-289-4524
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN188931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical