Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 20219 | MN |
NPI | 1003211400 |
---|---|
Provider Name | Lacy Osborne |
First Address | New Brighton, MN 55112-1786 |
Second Address | Rochester, MN 55904-7973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2014 |
Last Update Date | 12/09/2018 |