Healthcare Provider Details

I. General information

NPI: 1225439771
Provider Name (Legal Business Name): LAURA ANNE DAVIS PH.D., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 METRO BLVD STE 550
EDINA MN
55439-1353
US

IV. Provider business mailing address

7201 METRO BLVD STE 550
EDINA MN
55439-1353
US

V. Phone/Fax

Practice location:
  • Phone: 605-359-8572
  • Fax:
Mailing address:
  • Phone: 605-359-8572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP 5780
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: