Provider Demographics
NPI:1508123837
Name:TROBAUGH, DESIREE' LYNN (LADC)
Entity Type:Individual
Prefix:
First Name:DESIREE'
Middle Name:LYNN
Last Name:TROBAUGH
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3614
Mailing Address - Country:US
Mailing Address - Phone:651-645-3661
Mailing Address - Fax:651-645-0959
Practice Address - Street 1:1706 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3614
Practice Address - Country:US
Practice Address - Phone:651-645-3661
Practice Address - Fax:651-645-0959
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302282101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)