1. Home
  2. Directory
  3. Minnesota
  4. Burnsville
  5. Clinic Center
  6. NPI Profile

LIFESPAN OF MINNESOTA, INC.
NPI 1710097274
Clinic/Center - Mental Health (Including Community Mental Health Center) in Burnsville, MN

Active since August 30, 2006
12425 RIVER RIDGE BLVD, #200, BURNSVILLE, MN 55337(952) 562-8500(952) 562-8501 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 21, 2022, Jun 21, 2018, Mar 17, 2018 and 3 more (6 updates tracked since 2015).

About Lifespan Of Minnesota, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LIFESPAN OF MINNESOTA, INC. (NPI 1710097274) is a healthcare organization registered as a mental health (including community mental health center) in Burnsville, Minnesota and active in the NPI registry since August 2006. The organization maintains a secondary practice location in Maple Grove and lists Traci Lee Hackmann, Ceo/clinical Director, as its authorized official.

NPPES Registry Identity

NPI1710097274
Entity TypeOrganization
Primary Taxonomy261QM0801X
Legal Business NameLIFESPAN OF MINNESOTA, INC.
Location Address12425 RIVER RIDGE BLVD, #200Burnsville, MN 55337-4871
Mailing Address12425 River Ridge Blvd, #200Burnsville, MN 55337-4871 · (952) 562-8500 · Fax (952) 562-8501
Phone(952) 562-8500
Fax(952) 562-8501
Organization SubpartNo
Authorized OfficialTraci Lee HackmannCeo/clinical Director · (952) 562-8500
Enumeration DateAugust 30, 2006
Last NPPES UpdateJuly 21, 20226 updates tracked since enumeration
✔ NPI 1710097274 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities
Taxonomy Code261QM0801X
Licenses✔ Licensed in MN · 7076053 00✔ Licensed in MN · 7876190 00
12425 RIVER RIDGE BLVD, Burnsville, MN 55337
Open in Google Maps ↗

Secondary Practice Location 1

Location 113000 63rd Ave NMaple Grove, MN 55369-6081 · Phone (763) 553-4003 · Fax (763) 553-7743

Other Identifiers 5

Medicaid707605300MN
Other100598MN · Healthpartners
Other102020MN · Ucare
Other454T4DAMN · Blue Cross Blue Shield
Medicaid787619000MN

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EMILY LABUKAS LMFT
Marriage & Family Therapist
12425 RIVER RIDGE BLVD, #200
BURNSVILLE, MN 55337
Dakota County (952) 562-8500
MRS. JILL ELIZABETH SMITH LICSW
Social Worker (Clinical)
12425 RIVER RIDGE BLVD, #200
BURNSVILLE, MN 55337
Dakota County (952) 562-8500

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lifespan Of Minnesota, Inc.'s NPI number?

The NPI number for Lifespan Of Minnesota, Inc. is 1710097274. It was assigned to this organization in the NPPES registry on August 30, 2006.

Where is Lifespan Of Minnesota, Inc. located?

Lifespan Of Minnesota, Inc. is located at 12425 River Ridge Blvd #200, Burnsville, MN 55337. The listed phone number is (952) 562-8500.

What is Lifespan Of Minnesota, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

When was this NPI record last updated?

The NPPES record for Lifespan Of Minnesota, Inc. was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.