Provider Demographics
NPI:1093998593
Name:BREWER, LAURA G (PSYD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:G
Last Name:BREWER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:GRAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:285 N JANACEK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6102
Mailing Address - Country:US
Mailing Address - Phone:262-641-9050
Mailing Address - Fax:
Practice Address - Street 1:101 E PIER ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1939
Practice Address - Country:US
Practice Address - Phone:262-284-3117
Practice Address - Fax:262-284-3087
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2646-057103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling