Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Organization
LIFESPAN OF MINNESOTA, INC.
Active
Organization
LIFESPAN OF MINNESOTA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACI LEE HACKMANN MA LP (CEO/CLINICAL DIRECTOR)
(952) 562-8500
Entity
Organization
Contact information
Practice address
12425 RIVER RIDGE BLVD, #200, BURNSVILLE, MN 55337-4871
(952) 562-8500
(952) 562-8501
Mailing address
12425 RIVER RIDGE BLVD, #200, BURNSVILLE, MN 55337-4871
(952) 562-8500
(952) 562-8501
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
7076053 00
MN
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
7876190 00
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100598
HEALTHPARTNERS
MN
01
—
102020
UCARE
MN
01
—
454T4DA
BLUE CROSS BLUE SHIELD
MN
05
—
707605300
—
MN
05
—
787619000
—
MN
Enumeration date
08/30/2006
Last updated
07/21/2022
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up