MEDICARE: MS. LAURA ELIZABETH RADEMACHER M.A.

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1861742884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA ELIZABETH RADEMACHER M.A.

Provider Business Mailing Address
First Line	:	5871 CEDAR LAKE RD S STE 220
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-3804
Country	:	US
Telephone Number	:	612-460-0828
Fax Number	:

Provider Business Practice Location Address
First Line	:	5871 CEDAR LAKE RD S STE 220
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-3804
Country	:	US
Telephone Number	:	612-460-0828
Fax Number	:

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

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	09/17/2012

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