Provider Demographics
NPI:1306395579
Name:DUPRIE, LAURA LEE
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEE
Last Name:DUPRIE
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 1:319 PARK ST
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1655
Mailing Address - Country:US
Mailing Address - Phone:269-685-9401
Mailing Address - Fax:
Practice Address - Street 1:319 PARK ST
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1655
Practice Address - Country:US
Practice Address - Phone:269-685-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011001621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical