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General NPI Number Information
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NPI Number | 1003341801
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Entity Type | Organization
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Legal Business Name | LASKI MENTAL WELLNESS & COUNSELING, LLC
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Dates
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Enumeration Date | 04/29/2017
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 7101 YORK AVE S STE 145
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City | EDINA
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State | MN
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Zip | 55435-4484
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Country | US
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Telephone | 612-202-0535
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Fax | 763-999-6107
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Provider Business Mailing Address
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Address Line | 2867 JAMES AVE S APT 4
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-1890
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Country | US
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Telephone | 612-202-0535
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Fax | 612-224-9655
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDRA JANE LASKI
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Credential | DSW, M.ED., LICSW, L
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Telephone | 612-202-0535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 18622
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License Number State | MN
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