Provider Demographics
NPI:1649061714
Name:LAZIK, IVAN
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:LAZIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 FOX VALLEY PL SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-2498
Mailing Address - Country:US
Mailing Address - Phone:507-244-5858
Mailing Address - Fax:
Practice Address - Street 1:401 16TH ST SE STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-7974
Practice Address - Country:US
Practice Address - Phone:507-473-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional