Provider Demographics
NPI:1831417781
Name:LAKNER, MARY (MA, LP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LAKNER
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26357 FOREST BLVD
Mailing Address - Street 2:#5
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-8353
Mailing Address - Country:US
Mailing Address - Phone:651-462-6644
Mailing Address - Fax:
Practice Address - Street 1:26357 FOREST BLVD
Practice Address - Street 2:#5
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8353
Practice Address - Country:US
Practice Address - Phone:651-462-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-16
Last Update Date:2010-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0863103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist