Provider Demographics
NPI:1518904911
Name:VOLDAHL, LAURA LEE (MSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:VOLDAHL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 PARK ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 SILVER LAKE RD NW STE 110
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-1789
Practice Address - Country:US
Practice Address - Phone:651-628-9566
Practice Address - Fax:651-628-0411
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN127951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1019245OtherPREFERREDONE
MN126418OtherUCARE MINNESOTA
MNHP32927OtherHEALTHPARTNERS
MN62-51554OtherUNITED BEHAVIORAL HEALTH
MN126418OtherUCARE MINNESOTA
MN554135200Medicare ID - Type Unspecified