Provider Demographics
NPI:1699490474
Name:DESLAURIERS, LISA MARIE
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:DESLAURIERS
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 1:2245 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1159
Mailing Address - Country:US
Mailing Address - Phone:651-263-2144
Mailing Address - Fax:
Practice Address - Street 1:2245 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1159
Practice Address - Country:US
Practice Address - Phone:651-263-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)