MEDICARE: MRS. LORI ANN WIEDNER LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4674	MN

General Provider Information

NPI Number	:	1053134684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI ANN WIEDNER LPCC

Provider Business Mailing Address
First Line	:	20600 INDIA AVE
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-5903
Country	:	US
Telephone Number	:	952-297-4608
Fax Number	:

Provider Business Practice Location Address
First Line	:	18598 ELK RIVER TRL
Second Line	:
City	:	FARMINGTON
State	:	MN
Zip	:	55024-8640
Country	:	US
Telephone Number	:	651-333-0653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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