Individual
SHANNON G LACKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1554 MIDWAY PKWY APT 448, SAINT PAUL, MN 55108-2464
(218) 639-2150
Mailing address
6381 OSGOOD AVE N BLDG C, STILLWATER, MN 55082-6118
(651) 560-5275
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2993
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356907026
COMMERCIAL
MN
Enumeration date
05/17/2019
Last updated
02/20/2023
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