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Laurie K. Tazelaar-williams
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in White Bear Lake, Minnesota
NPI 1154814564

Laurie K. Tazelaar-williams is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in White Bear Lake, MN. Laurie K. Tazelaar-williams practices in White Bear Lake, MN. The NPI Number for Laurie K. Tazelaar-williams is 1154814564 and holds a License No. (Minnesota).

The current practice location address for Laurie K. Tazelaar-williams is 5253 W Bald Eagle Blvd, White Bear Lake, MN and can be reached out via phone at 612-380-3333.

Location: 5253 W Bald Eagle Blvd, White Bear Lake, MN, 55110-0818
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1154814564
Provider Name
Laurie K. Tazelaar-williams
Credential
Provider Entity Type
Individual
Gender
Female
Address
5253 W Bald Eagle Blvd, White Bear Lake, MN, 55110-0818
Phone Number
612-380-3333
Fax Number
Provider Enumeration Date
06/11/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
5253 W Bald Eagle Blvd
City
White Bear Lake
State
Minnesota
Zip
55110-6532
Phone Number
612-380-3333
Fax Number
person
Provider Business Mailing Address Details
Address
5253 W Bald Eagle Blvd
City
White Bear Lake
State
Minnesota
Zip
55110-6532
Phone Number
612-380-3333
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
(Minnesota)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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