Provider Demographics
NPI:1528449899
Name:KEGLEY, LAURA B (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:KEGLEY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:B
Other - Last Name:RAUENHORST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:151 W BURNSVILLE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2525
Mailing Address - Country:US
Mailing Address - Phone:952-564-3000
Mailing Address - Fax:651-925-0256
Practice Address - Street 1:151 W BURNSVILLE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2525
Practice Address - Country:US
Practice Address - Phone:952-564-3000
Practice Address - Fax:651-925-0256
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN212151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21215OtherLICSW