Provider Demographics
NPI:1619468147
Name:PEABODY, LAUREN (LAC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PEABODY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28070 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-7952
Mailing Address - Country:US
Mailing Address - Phone:952-738-2645
Mailing Address - Fax:
Practice Address - Street 1:7550 FRANCE AVE S STE 240
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4821
Practice Address - Country:US
Practice Address - Phone:952-830-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1870171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty