Provider Demographics
NPI:1568427292
Name:LODERMEIER, LARRY PATRICK (MS LP LMFT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:PATRICK
Last Name:LODERMEIER
Suffix:
Gender:M
Credentials:MS LP LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 AUSTIN ROAD
Mailing Address - Street 2:STE 2
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060
Mailing Address - Country:US
Mailing Address - Phone:507-446-8123
Mailing Address - Fax:507-446-0600
Practice Address - Street 1:1880 AUSTIN ROAD
Practice Address - Street 2:STE 2
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060
Practice Address - Country:US
Practice Address - Phone:507-446-8123
Practice Address - Fax:507-446-0600
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2176103T00000X
MN291106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN444S2L0OtherBCBSM
MN6244359OtherUBH
MN117951OtherUCARE