Provider Demographics
NPI:1235480237
Name:LAUX, WALTER
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:LAUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W VIRGINIA ST
Mailing Address - Street 2:STE 203
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1500
Mailing Address - Country:US
Mailing Address - Phone:414-831-4500
Mailing Address - Fax:414-255-3451
Practice Address - Street 1:9401 W BELOIT RD STE 314
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-4357
Practice Address - Country:US
Practice Address - Phone:414-539-4862
Practice Address - Fax:414-240-0761
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15918-132101YA0400X
WI449689101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100026878Medicaid