Individual
MS. LISA LOUISE WOODRUFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LP,LICSW
Contact information
Practice address
4505 WHITE BEAR PKWY, SUITE 1800, WHITE BEAR LAKE, MN 55110-3678
(651) 426-8191
(651) 426-6766
Mailing address
4505 WHITE BEAR PKWY, SUITE 1800, WHITE BEAR LAKE, MN 55110-3678
(651) 426-8191
(651) 426-6766
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
LP0870
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62-06159
UBH
MN
Enumeration date
10/19/2006
Last updated
07/08/2007
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