Provider Demographics
NPI:1538842331
Name:HALVORSEN FREGARD, LAURA JANET (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JANET
Last Name:HALVORSEN FREGARD
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-1258
Mailing Address - Country:US
Mailing Address - Phone:218-209-2930
Mailing Address - Fax:
Practice Address - Street 1:4501 GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-1258
Practice Address - Country:US
Practice Address - Phone:218-209-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN291901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical