Provider Demographics
NPI:1437383619
Name:LAUENBACHER, SUSAN LOIS (M,ED)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LOIS
Last Name:LAUENBACHER
Suffix:
Gender:F
Credentials:M,ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 INGHAM ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-2874
Mailing Address - Country:US
Mailing Address - Phone:412-322-0140
Mailing Address - Fax:412-322-4626
Practice Address - Street 1:1450 INGHAM ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-2874
Practice Address - Country:US
Practice Address - Phone:412-322-0140
Practice Address - Fax:412-322-4626
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA2707609059OtherPDE CERTIFICATION IN SPECIAL EDUCATION