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General NPI Number Information
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NPI Number | 1336028372
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Entity Type | Individual
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Provider Name | LARAE MARIE LETEXIER LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 2040 WOODWINDS DR
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City | WOODBURY
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State | MN
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Zip | 55125-2522
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Country | US
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Telephone | 651-259-9750
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Fax | 651-259-9790
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Provider Business Mailing Address
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Address Line | 141 4TH ST E APT 725
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City | SAINT PAUL
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State | MN
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Zip | 55101-2505
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Country | US
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Telephone | 218-773-6413
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12271-123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34859
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License Number State | MN
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