MEDICARE: LAURA STEPHAN PSYD, 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

General Provider Information

NPI Number	:	1831566991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA STEPHAN PSYD, LP

Provider Business Mailing Address
First Line	:	475 CLEVELAND AVE N STE 311
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-5053
Country	:	US
Telephone Number	:	651-728-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 CLEVELAND AVE N STE 311
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-5053
Country	:	US
Telephone Number	:	651-728-4500
Fax Number	:

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

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	06/09/2023

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