Provider Demographics
NPI:1588954747
Name:LASCH, STEPHANIE (LCMT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LASCH
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6776 LAKE DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1191
Mailing Address - Country:US
Mailing Address - Phone:651-788-9219
Mailing Address - Fax:651-344-0776
Practice Address - Street 1:6776 LAKE DR
Practice Address - Street 2:SUITE 170
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1191
Practice Address - Country:US
Practice Address - Phone:651-788-9219
Practice Address - Fax:651-344-0776
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist