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General NPI Number Information
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NPI Number | 1053184267
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Entity Type | Individual
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Provider Name | LAURA KATHERINE JAYROE LPCC
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Gender | Female
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 1000 RADIO DR STE 210
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City | WOODBURY
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State | MN
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Zip | 55125-8444
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Country | US
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Telephone | 651-395-5777
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Fax |
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Provider Business Mailing Address
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Address Line | 4644 BLAINE AVE
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-1313
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Country | US
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Telephone | 318-676-2930
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4101
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License Number State | MN
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