Provider Demographics
NPI:1770874943
Name:ANDERSON, LAURA R (LADC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:ANDERSON
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 1:1600 HIGHWAY 55
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-2368
Mailing Address - Country:US
Mailing Address - Phone:651-438-8236
Mailing Address - Fax:651-438-8252
Practice Address - Street 1:1600 HIGHWAY 55
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2368
Practice Address - Country:US
Practice Address - Phone:651-438-8236
Practice Address - Fax:651-438-8252
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302267101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)