Provider Demographics
NPI:1114252939
Name:RADTKE- ROUNDS, LAUREN (PHD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:RADTKE- ROUNDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21149 DUNDEE DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4743
Mailing Address - Country:US
Mailing Address - Phone:248-962-5064
Mailing Address - Fax:
Practice Address - Street 1:21149 DUNDEE DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4743
Practice Address - Country:US
Practice Address - Phone:248-962-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014131103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical