Provider Demographics
NPI:1902888555
Name:NELSON, LORI ANN (MSED, LP)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSED, LP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:NELSON EGGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, LP
Mailing Address - Street 1:600 25TH AVE S
Mailing Address - Street 2:STE 109
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4841
Mailing Address - Country:US
Mailing Address - Phone:320-255-0343
Mailing Address - Fax:320-654-0318
Practice Address - Street 1:600 25TH AVE S
Practice Address - Street 2:STE 109
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4841
Practice Address - Country:US
Practice Address - Phone:320-255-0343
Practice Address - Fax:320-654-0318
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3099103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
110216OtherUCARE
411768605OtherCERIDIAN
MN785325400Medicaid
6262609OtherUBH MEDICA SELECT CARE
82D17NEOtherBCBS COMP CARE
2315034OtherAMERICAS PPO
766591015131OtherPREFERRED ONE
187408OtherMAYO MANAGEMENT
337324OtherVALUE OPTIONS