Provider Demographics
NPI:1295530111
Name:STREIT, LISA ANN (LADC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:STREIT
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10311 CEDAR LAKE RD APT 105
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-3259
Mailing Address - Country:US
Mailing Address - Phone:320-310-2258
Mailing Address - Fax:
Practice Address - Street 1:7831 GLENROY RD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55439-3132
Practice Address - Country:US
Practice Address - Phone:651-447-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306461101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)