Provider Demographics
NPI:1164016275
Name:LAHN, JUSTINE NICOLE (LICSW)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:NICOLE
Last Name:LAHN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:NICOLE
Other - Last Name:BRANDIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7362 UNIVERSITY AVE NE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3152
Mailing Address - Country:US
Mailing Address - Phone:763-503-3981
Mailing Address - Fax:763-503-3981
Practice Address - Street 1:7362 UNIVERSITY AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3152
Practice Address - Country:US
Practice Address - Phone:763-503-3981
Practice Address - Fax:763-503-3981
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN265471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty