MEDICARE: LORI A. WINTER 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
2	103TC0700X	Clinical Psychologist	LP4808	MN

General Provider Information

NPI Number	:	1760619290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI A. WINTER LP

Provider Business Mailing Address
First Line	:	678 90TH AVE
Second Line	:
City	:	LUVERNE
State	:	MN
Zip	:	56156-4184
Country	:	US
Telephone Number	:	605-360-5690
Fax Number	:	800-878-8212

Provider Business Practice Location Address
First Line	:	678 90TH AVE
Second Line	:
City	:	LUVERNE
State	:	MN
Zip	:	56156-4184
Country	:	US
Telephone Number	:	605-360-5690
Fax Number	:	800-878-8212

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

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	09/23/2024

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