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NPI Code Detail

MEDICARE: LAURA MCKEE WELP LICSW, LADC

MEDICARE: LAURA MCKEE WELP LICSW, LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor31156IL
21041C0700XClinical Social Worker28599MN
31041C0700XClinical Social Worker149.017654IL

General Provider Information

NPI Number : 1114468246
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA MCKEE WELP LICSW, LADC
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW STE 110
Second Line :
City : NEW BRIGHTON
State : MN
Zip : 55112-1789
Country : US
Telephone Number : 651-628-9566
Fax Number : 651-628-0411
Provider Business Practice Location Address
First Line : 1715 TOWER DR W STE 100
Second Line :
City : STILLWATER
State : MN
Zip : 55082-7609
Country : US
Telephone Number : 651-390-5001
Fax Number : 651-390-5002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2017
Last Update Date : 08/19/2022

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