Individual provider · Type 1 NPI
Laurie K. Tazelaar-Williams
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · White Bear Lake, MN
Practice location
5253 W Bald Eagle Blvd
White Bear Lake, MN 55110-6532
Mailing address
PO Box 10818
White Bear Lake, MN 55110-0818
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary | 320900000X | None listed |
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
About NPI 1154814564
Laurie K. Tazelaar-Williams's National Provider Identifier is 1154814564, issued on Jun 11, 2018. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in White Bear Lake, MN. The record was last updated on Jun 11, 2018.