Healthcare Provider Details

I. General information

NPI: 1275250409
Provider Name (Legal Business Name): LAURA OATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 80TH CIR N STE 200
MAPLE GROVE MN
55369-9801
US

IV. Provider business mailing address

100 N. PCH HWY SUITE 1400
EL SEGUNDO CA
90245
US

V. Phone/Fax

Practice location:
  • Phone: 651-243-6556
  • Fax:
Mailing address:
  • Phone: 310-856-0800
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2834825
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: