Provider Demographics
NPI:1437652518
Name:LACONIC, EMILY J (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:LACONIC
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 1:10505 WAYZATA BLVD STE 203-7
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1502
Mailing Address - Country:US
Mailing Address - Phone:612-219-7620
Mailing Address - Fax:612-256-4865
Practice Address - Street 1:10505 WAYZATA BLVD STE 203-7
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1502
Practice Address - Country:US
Practice Address - Phone:612-219-7620
Practice Address - Fax:612-256-4865
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN166521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical