Provider Demographics
NPI:1417599382
Name:GAVIN, LAUREN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GAVIN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 BIELENBERG DR STE 104
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4416
Mailing Address - Country:US
Mailing Address - Phone:651-706-1850
Mailing Address - Fax:
Practice Address - Street 1:652 BIELENBERG DR STE 104
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4416
Practice Address - Country:US
Practice Address - Phone:651-706-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN264051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical