Provider Demographics
NPI:1831624030
Name:GORACZKOWSKI, LAURA R (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:GORACZKOWSKI
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:RUTH
Other - Last Name:RINDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:14 6TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1160
Mailing Address - Country:US
Mailing Address - Phone:320-634-3446
Mailing Address - Fax:320-634-0384
Practice Address - Street 1:14 6TH AVE NW
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1160
Practice Address - Country:US
Practice Address - Phone:320-634-3446
Practice Address - Fax:320-634-0384
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN189601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical