Healthcare Provider Details

I. General information

NPI: 1366074197
Provider Name (Legal Business Name): LAURA BATTAGLIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 WAYZATA BLVD
SAINT LOUIS PARK MN
55416-1222
US

IV. Provider business mailing address

5775 WAYZATA BLVD
SAINT LOUIS PARK MN
55416-1222
US

V. Phone/Fax

Practice location:
  • Phone: 942-525-4500
  • Fax:
Mailing address:
  • Phone: 952-525-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number24875
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: