Basic Information
Provider Information
NPI: 1902365380
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAABS
FirstName: ARIEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RBT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2804 E 26TH ST STE 1
Address2:  
City: SIOUX FALLS
State: SD
PostalCode: 571034019
CountryCode: US
TelephoneNumber: 6052712690
FaxNumber: 6052713956
Practice Location
Address1: 3721 23RD ST S # 201
Address2:  
City: SAINT CLOUD
State: MN
PostalCode: 563016198
CountryCode: US
TelephoneNumber: 6052712690
FaxNumber: 6052713956
Other Information
ProviderEnumerationDate: 03/15/2019
LastUpdateDate: 10/15/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  Y    

No ID Information.


Home