Provider Demographics
NPI:1811225592
Name:NECHANICKY, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:NECHANICKY
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 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:332 W SUPERIOR ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1808
Practice Address - Country:US
Practice Address - Phone:218-722-4379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN179665101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor