Basic Information
| Provider Information | |||||||||
| NPI: | 1619378320 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUCCI | ||||||||
| FirstName: | INGRID | ||||||||
| MiddleName: | SARIANNA | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 563 BIELENBERG DR STE 125 | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551254426 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6043 HUDSON RD STE 220 | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551251033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6519258200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2014 | ||||||||
| LastUpdateDate: | 01/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 886 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.