Provider Demographics
NPI:1962298224
Name:WERTHAUSER, DEVIN LANI (LADC)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:LANI
Last Name:WERTHAUSER
Suffix:
Gender:
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2154 CHARLTON RD
Mailing Address - Street 2:
Mailing Address - City:SUNFISH LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55118-4737
Mailing Address - Country:US
Mailing Address - Phone:651-276-9314
Mailing Address - Fax:
Practice Address - Street 1:6916 LAKE TER E
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3966
Practice Address - Country:US
Practice Address - Phone:651-204-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN307011101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)