Provider Demographics
NPI:1053134684
Name:WIEDNER, LORI ANN (LPCC)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:WIEDNER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20600 INDIA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5903
Mailing Address - Country:US
Mailing Address - Phone:952-297-4608
Mailing Address - Fax:
Practice Address - Street 1:18598 ELK RIVER TRL
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-8640
Practice Address - Country:US
Practice Address - Phone:651-333-0653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health