Provider Demographics
NPI:1902551971
Name:SALAZAR, LAURA (BCTMB)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 SCHOOL AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-2030
Mailing Address - Country:US
Mailing Address - Phone:612-702-2061
Mailing Address - Fax:
Practice Address - Street 1:261 SCHOOL AVE STE 220
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-2030
Practice Address - Country:US
Practice Address - Phone:612-702-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN