Healthcare Provider Details

I. General information

NPI: 1306775127
Provider Name (Legal Business Name): ANN MARIE LACOURSE BS, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CIVIC CENTER PLZ STE 2116
MANKATO MN
56001-7789
US

IV. Provider business mailing address

PO BOX 291
MANKATO MN
56002-0291
US

V. Phone/Fax

Practice location:
  • Phone: 507-385-8774
  • Fax: 507-345-1895
Mailing address:
  • Phone: 507-385-8774
  • Fax: 507-345-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305590
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: