Healthcare Provider Details

I. General information

NPI: 1740126846
Provider Name (Legal Business Name): LAURA DAWN SOSALLA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA DAWN HUME

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 SELBY AVE STE 111
SAINT PAUL MN
55104-6285
US

IV. Provider business mailing address

1595 SELBY AVE STE 111
SAINT PAUL MN
55104-6285
US

V. Phone/Fax

Practice location:
  • Phone: 612-200-0267
  • Fax: 763-373-9463
Mailing address:
  • Phone: 612-200-0267
  • Fax: 763-373-9463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number05542
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: