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General NPI Number Information
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NPI Number | 1689539470
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Entity Type | Individual
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Provider Name | LARA MADALYN WEAVER LSW, MSW
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Gender | Female
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 1870 50TH ST E STE 7
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55077-1270
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Country | US
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Telephone | 651-318-0334
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Fax |
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Provider Business Mailing Address
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Address Line | 1870 50TH ST E STE 7
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55077-1270
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Country | US
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Telephone | 651-318-0334
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | SW140946
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW140946
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License Number State | PA
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