Basic Information
| Provider Information | |||||||||
| NPI: | 1649499450 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOIGHT-RADTKE | ||||||||
| FirstName: | LAURA | ||||||||
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| Credential: | LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 ERICKSON HERITAGE NE | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563088960 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 460 NORTHSIDE DR NE STE 5 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563082355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014514900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 4632 | MN | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | HP69866 | 01 | MN | HEALTH PARTNERS | OTHER | 56308-A005 | 01 | MN | TRI WEST | OTHER | 812T7RA | 01 | MN | BCBS MN | OTHER |