Healthcare Provider Details

I. General information

NPI: 1225335011
Provider Name (Legal Business Name): LINDA ALMA LAZIER L.A.D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9613 GIRARD AVE S
BLOOMINGTON MN
55431-2619
US

IV. Provider business mailing address

15035 OAKCREST CT
SAVAGE MN
55378-4648
US

V. Phone/Fax

Practice location:
  • Phone: 612-481-5803
  • Fax:
Mailing address:
  • Phone: 612-481-5803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number301254
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: