Individual
LACEY SEVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2120 CLINTON AVE, MINNEAPOLIS, MN 55404-2649
(952) 405-7190
Mailing address
6140 QUINWOOD LN N APT 4114, PLYMOUTH, MN 55442-1294
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
26356
MN
Other
Enumeration date
02/10/2020
Last updated
02/10/2020
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