Individual
LACY RAE KAUSHAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DSP
Contact information
Practice address
45 ADAMS BLVD, SILVER BAY, MN 55614-1326
(218) 213-2708
Mailing address
45 ADAMS BLVD, SILVER BAY, MN 55614-1326
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
137304120250223
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137304120250223
PCA AND CFSS CERTIFICATION
MN
Enumeration date
05/14/2026
Last updated
05/14/2026
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