Provider Demographics
NPI:1114445129
Name:POND, LAURAL LEE (MT-BC, DP)
Entity Type:Individual
Prefix:
First Name:LAURAL
Middle Name:LEE
Last Name:POND
Suffix:
Gender:F
Credentials:MT-BC, DP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3009
Mailing Address - Country:US
Mailing Address - Phone:906-273-0964
Mailing Address - Fax:
Practice Address - Street 1:104 MALTON RD
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-2000
Practice Address - Country:US
Practice Address - Phone:906-228-4692
Practice Address - Fax:906-228-2830
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225A00000X
MI68511107411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist