Provider Demographics
NPI:1770062655
Name:SUFLITA, LAURA ABIGAIL
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ABIGAIL
Last Name:SUFLITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 CENTRE POINTE DR STE 7
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1377
Mailing Address - Country:US
Mailing Address - Phone:952-401-9359
Mailing Address - Fax:
Practice Address - Street 1:1160 CENTRE POINTE DR STE 7
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1377
Practice Address - Country:US
Practice Address - Phone:952-401-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician