Healthcare Provider Details

I. General information

NPI: 1972974459
Provider Name (Legal Business Name): LAURA KUZZY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 RAYMOND AVE STE 105
SAINT PAUL MN
55114-1701
US

IV. Provider business mailing address

970 RAYMOND AVE STE 105
SAINT PAUL MN
55114-1701
US

V. Phone/Fax

Practice location:
  • Phone: 763-280-4487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC01819
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: