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NPI Code Detail

MEDICARE: STELLA RAE LACROIX-DALLUHN

MEDICARE:   STELLA RAE LACROIX-DALLUHN
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1336988963
Entity Type Code : Individual
Provider Name (Legal Business Name) : STELLA RAE LACROIX-DALLUHN
Provider Business Mailing Address
First Line : 1519 CHELSEA ST
Second Line :
City : SAINT PAUL
State : MN
Zip : 55108-2311
Country : US
Telephone Number : 651-368-3352
Fax Number :
Provider Business Practice Location Address
First Line : 1519 CHELSEA ST
Second Line :
City : SAINT PAUL
State : MN
Zip : 55108-2311
Country : US
Telephone Number : 651-368-3352
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2024
Last Update Date : 05/22/2024

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Directions to “ STELLA RAE LACROIX-DALLUHN ” Practice Location

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