Provider Demographics
NPI:1427584440
Name:MCLEOD, LAUREN KAY
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:KAY
Last Name:MCLEOD
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:W321S8900 LEAH WAY
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-8257
Mailing Address - Country:US
Mailing Address - Phone:262-993-1468
Mailing Address - Fax:
Practice Address - Street 1:W321S8900 LEAH WAY
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8257
Practice Address - Country:US
Practice Address - Phone:262-993-1468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIM2435319367908390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program