Provider Demographics
NPI:1952854051
Name:BOELTER, LAUREN (LICSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BOELTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 UNIVERSITY AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3325
Mailing Address - Country:US
Mailing Address - Phone:612-728-5399
Mailing Address - Fax:612-728-5301
Practice Address - Street 1:2030 RAHN WAY
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2300
Practice Address - Country:US
Practice Address - Phone:612-728-5399
Practice Address - Fax:612-728-5301
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN224301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical