MEDICARE: DR. LANA I. BOUTACOFF PHD, LP

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	103T00000X	Psychologist	LP2623	MN

General Provider Information

NPI Number	:	1437213469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANA I. BOUTACOFF PHD, LP

Provider Business Mailing Address
First Line	:	570 ASBURY ST
Second Line	:	SUITE 104
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1849
Country	:	US
Telephone Number	:	651-645-7318
Fax Number	:	651-645-0974

Provider Business Practice Location Address
First Line	:	570 ASBURY ST
Second Line	:	SUITE 104
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1849
Country	:	US
Telephone Number	:	651-645-7318
Fax Number	:	651-645-0974

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

Similar Medicare Providers

1407960032 — STEVEN ALLEN BLACKWELL PH.D., J.D., R.PH.
Practice Location Address:

7500 SECURITY BLVD # C3-20-17 , CENTERS FOR MEDICARE & MEDICAID SERVICES
BALTIMORE, MD
21244-1849

Practice Phone: 410-786-6852
Practice Fax:

1669546479 — DR. SANDRA KAY HEWITT PHD
Practice Location Address:

570 ASBURY ST , SUITE 310
SAINT PAUL, MN
55104-1849

Practice Phone: 651-646-7010
Practice Fax: 651-646-7668

1104898642 — KATHLEEN M PFAFFINGER PHD LP
Practice Location Address:

570 ASBURY ST , SUITE 103
SAINT PAUL, MN
55104-1849

Practice Phone: 651-646-1777
Practice Fax: 651-646-1774

1528081015 — DR. DIANE LYN WILSON MD
Practice Location Address:

570 ASBURY ST , SUITE 106B
SAINT PAUL, MN
55104-1849

Practice Phone: 612-802-4704
Practice Fax:

1629183173 — GEORGANNE FARSETH PH D LP
Practice Location Address:

570 ASBURY ST , SUITE 310
SAINT PAUL, MN
55104-1849

Practice Phone: 651-646-7010
Practice Fax: 651-646-7668

1184714461 — DAVID WILLIAM HORSTMANN M.S., L.P., L.M.F.T.
Practice Location Address:

570 ASBURY ST , STE. 103
SAINT PAUL, MN
55104-1849

Practice Phone: 651-641-0516
Practice Fax:

Directions to “ DR. LANA I. BOUTACOFF PHD, LP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.