Provider Demographics
NPI:1033498993
Name:ASSADI, LAURIE L (MA, EDS, LLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:L
Last Name:ASSADI
Suffix:
Gender:F
Credentials:MA, EDS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 SOUTH WESTNEDGE
Mailing Address - Street 2:SUITE 2101
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3286
Mailing Address - Country:US
Mailing Address - Phone:269-384-2270
Mailing Address - Fax:269-384-3319
Practice Address - Street 1:4341 SOUTH WESTNEDGE
Practice Address - Street 2:SUITE 2101
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3286
Practice Address - Country:US
Practice Address - Phone:269-384-2270
Practice Address - Fax:269-384-3319
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002922103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical