Provider Demographics
NPI:1689155624
Name:LAUDENBACH, LORI KAY (MA, LPCC, NCC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KAY
Last Name:LAUDENBACH
Suffix:
Gender:F
Credentials:MA, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 ATWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9130
Mailing Address - Country:US
Mailing Address - Phone:320-493-8365
Mailing Address - Fax:
Practice Address - Street 1:2025 STEARNS WAY STE 114
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1275
Practice Address - Country:US
Practice Address - Phone:320-656-7195
Practice Address - Fax:320-200-3245
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00758101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional