Provider Demographics
NPI:1962581082
Name:LATZKE, DEBORAH (MS, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:LATZKE
Suffix:
Gender:F
Credentials:MS, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29150 441ST AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MN
Mailing Address - Zip Code:55334-2202
Mailing Address - Country:US
Mailing Address - Phone:218-790-2165
Mailing Address - Fax:
Practice Address - Street 1:760 ELMWOOD AVE S
Practice Address - Street 2:
Practice Address - City:LE SUEUR
Practice Address - State:MN
Practice Address - Zip Code:56058-2169
Practice Address - Country:US
Practice Address - Phone:507-931-8040
Practice Address - Fax:507-931-8060
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301854101YA0400X
MNCC00107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)