Healthcare Provider Details

I. General information

NPI: 1275246498
Provider Name (Legal Business Name): SAVANNA ROSE LACOURSIERE MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR STE 2400
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1200 6TH AVE N
SAINT CLOUD MN
56303-2735
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4916
  • Fax: 320-229-5174
Mailing address:
  • Phone: 203-240-2100
  • Fax: 320-240-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4238
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: