Lakeside Family Wellness LLC

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

LAKESIDE FAMILY WELLNESS LLC

Practice address

44314 Idas Rd
Osage, MN 56570-9363

Phone

(218) 396-9215

NPI assigned

Aug 25, 2025

Last updated

Aug 25, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gretchen SlavicekNPI 1194498386

Title

Owner

Phone

(218) 396-9215

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gretchen Slavicek, MS, LMFT

  • Marriage & Family Therapist
  • Bemidji, MN
  • NPI 1194498386
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1756080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756080000000",
    "number": "1205714409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44314 IDAS RD",
            "city": "OSAGE",
            "state": "MN",
            "postal_code": "565709363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44314 IDAS RD",
            "city": "OSAGE",
            "state": "MN",
            "postal_code": "565709363",
            "telephone_number": "218-396-9215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE FAMILY WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-25",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A",
        "authorized_official_last_name": "SLAVICEK",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-396-9215"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylea Burlingame, LSW
• Jaclyn Joan Hayes, RN
• North Star Nursing Temporary Associates, Inc.

• Marriage & Family Therapist in Osage, MN
• Providers in Osage, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.