Individual
DR. LANA I. BOUTACOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LP
Contact information
Practice address
570 ASBURY ST, SUITE 104, SAINT PAUL, MN 55104-1849
(651) 645-7318
(651) 645-0974
Mailing address
570 ASBURY ST, SUITE 104, SAINT PAUL, MN 55104-1849
(651) 645-7318
(651) 645-0974
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2623
MN
Other
Enumeration date
12/21/2006
Last updated
07/08/2007
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