Provider Demographics
NPI:1760858443
Name:LAUER-GLEBOV, JACQULYN (LAC)
Entity Type:Individual
Prefix:
First Name:JACQULYN
Middle Name:
Last Name:LAUER-GLEBOV
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 WEIR DR STE 24
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2282
Mailing Address - Country:US
Mailing Address - Phone:651-232-6830
Mailing Address - Fax:651-702-2636
Practice Address - Street 1:1740 WEIR DR STE 24
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-232-6830
Practice Address - Fax:651-702-2636
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1768171100000X
WI55-830171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist