Provider Demographics
NPI:1750839551
Name:SMEDSTAD, LURA
Entity Type:Individual
Prefix:
First Name:LURA
Middle Name:
Last Name:SMEDSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 DULUTH ST
Mailing Address - Street 2:SUITES # 306 & 316
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3946
Mailing Address - Country:US
Mailing Address - Phone:612-202-8703
Mailing Address - Fax:612-241-1943
Practice Address - Street 1:5851 DULUTH ST
Practice Address - Street 2:SUITES # 306 & 316
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3946
Practice Address - Country:US
Practice Address - Phone:612-202-8703
Practice Address - Fax:612-241-1943
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor