Provider Demographics
NPI:1417395757
Name:MALTSCH, LAUREN MICHAEL
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHAEL
Last Name:MALTSCH
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 1:3220 N 95TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3525
Mailing Address - Country:US
Mailing Address - Phone:262-853-3404
Mailing Address - Fax:
Practice Address - Street 1:5228 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1346
Practice Address - Country:US
Practice Address - Phone:414-871-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1216226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional