Provider Demographics
NPI:1871823377
Name:GLATZMAIER, DONALD LAWRENCE (LADC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:LAWRENCE
Last Name:GLATZMAIER
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 W DIVISION ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4515
Mailing Address - Country:US
Mailing Address - Phone:320-251-0035
Mailing Address - Fax:320-251-0209
Practice Address - Street 1:3333 W DIVISION ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4515
Practice Address - Country:US
Practice Address - Phone:320-251-0035
Practice Address - Fax:320-251-0209
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300979101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)