Provider Demographics
NPI:1235917774
Name:HAWK, LAUREN L
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:L
Last Name:HAWK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HATHAWAY ST TRLR 22
Mailing Address - Street 2:
Mailing Address - City:EAST CHINA
Mailing Address - State:MI
Mailing Address - Zip Code:48054-1586
Mailing Address - Country:US
Mailing Address - Phone:586-461-8400
Mailing Address - Fax:
Practice Address - Street 1:1159 S CARNEY DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-5569
Practice Address - Country:US
Practice Address - Phone:586-461-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician