MEDICARE: LAURA LEE VOLDAHL MSW

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
1	1041C0700X	Clinical Social Worker	12795	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1019245	OTHER	MN	PREFERREDONE
2	126418	OTHER	MN	UCARE MINNESOTA
3	HP32927	OTHER	MN	HEALTHPARTNERS
4	62-51554	OTHER	MN	UNITED BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1518904911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LEE VOLDAHL MSW

Provider Business Mailing Address
First Line	:	329 PARK ST
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3639
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location 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

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	06/26/2019

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