IndividualActive
Laurie Tazelaar-Williams
NPI 1154814564 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · White Bear Lake, MN
Provider details
- NPI number
- 1154814564
- Entity type
- Individual
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Female
- Sole proprietor
- Yes
Practice location
5253 W Bald Eagle Blvd
White Bear Lake, MN 55110-6532
Phone: (612) 380-3333
Mailing address
Po Box 10818
White Bear Lake, MN 55110-0818
Registry dates
- Enumerated
- 2018-06-11
- Last updated
- 2018-06-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.