Healthcare Provider Details

I. General information

NPI: 1003211400
Provider Name (Legal Business Name): LACY OSBORNE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WARREN ST # 324
MANKATO MN
56001-3762
US

IV. Provider business mailing address

100 WARREN ST # 324
MANKATO MN
56001-3762
US

V. Phone/Fax

Practice location:
  • Phone: 507-227-4858
  • Fax: 507-519-2271
Mailing address:
  • Phone: 507-344-3124
  • Fax: 507-519-2271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20219
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: