Provider Demographics
NPI:1437695624
Name:LINNER, LAURA (AM, LICSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LINNER
Suffix:
Gender:F
Credentials:AM, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 WAYZATA BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1275
Mailing Address - Country:US
Mailing Address - Phone:952-525-4500
Mailing Address - Fax:952-525-1560
Practice Address - Street 1:5775 WAYZATA BLVD STE 255
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1275
Practice Address - Country:US
Practice Address - Phone:952-525-4500
Practice Address - Fax:952-525-1560
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150102232104100000X
MN222981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker