=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124592175
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA HODGES LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2019
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8550 HUDSON BLVD N
-----------------------------------------------------
City | LAKE ELMO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55042-5500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-254-8580
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 S 2ND ST
-----------------------------------------------------
City | RIVER FALLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54022-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-504-2483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 3438
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------