Provider Demographics
NPI:1578627717
Name:LUTENEGGER, ARLENE R (LP)
Entity Type:Individual
Prefix:MS
First Name:ARLENE
Middle Name:R
Last Name:LUTENEGGER
Suffix:
Gender:F
Credentials:LP
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Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6490 EXCELSIOR BLVD
Practice Address - Street 2:SUITE W505
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426
Practice Address - Country:US
Practice Address - Phone:952-993-6200
Practice Address - Fax:952-993-6510
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP2237103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN113353500Medicaid