Provider Demographics
NPI:1548072549
Name:SCHLOTTERBACK, LAURA RENEE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:RENEE
Last Name:SCHLOTTERBACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 ARCADE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2615
Mailing Address - Country:US
Mailing Address - Phone:651-772-5555
Mailing Address - Fax:651-776-4776
Practice Address - Street 1:1165 ARCADE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2615
Practice Address - Country:US
Practice Address - Phone:651-772-5555
Practice Address - Fax:651-776-4776
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN314601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical