Healthcare Provider Details

I. General information

NPI: 1417870890
Provider Name (Legal Business Name): YAZMIN ALVARADO SOTO LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 GREELEY ST S STE 202
STILLWATER MN
55082-6279
US

IV. Provider business mailing address

202 N CEDAR AVE STE 1
OWATONNA MN
55060-2306
US

V. Phone/Fax

Practice location:
  • Phone: 612-234-2644
  • Fax: 651-390-5503
Mailing address:
  • Phone: 651-503-6903
  • Fax: 651-390-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29800
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: