Provider Demographics
NPI:1932506342
Name:LASCHKEWITSCH, TIFFANY (PSYD, LP, LADC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LASCHKEWITSCH
Suffix:
Gender:F
Credentials:PSYD, LP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3382
Mailing Address - Country:US
Mailing Address - Phone:612-326-3486
Mailing Address - Fax:
Practice Address - Street 1:2217 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3382
Practice Address - Country:US
Practice Address - Phone:612-326-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303601101YA0400X
MNLP5746103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)