Basic Information
| Provider Information | |||||||||
| NPI: | 1821554627 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUNIA | ||||||||
| FirstName: | LAURA LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 MONTROSE RD | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563019613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632671605 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1125 6TH ST SE | ||||||||
| Address2: | |||||||||
| City: | WILLMAR | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562014675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202354613 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2019 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | CC02033 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.