Provider Demographics
NPI:1508027764
Name:VUKONICH, LAURIE J (LMSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:VUKONICH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:J
Other - Last Name:HUTCHENREUTHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:2020 E GRAND RIVER
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843
Mailing Address - Country:US
Mailing Address - Phone:517-545-5944
Mailing Address - Fax:517-545-7390
Practice Address - Street 1:2020 E GRAND RIVER
Practice Address - Street 2:SUITE 104
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:517-545-5944
Practice Address - Fax:517-545-7390
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801082189104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M58290Medicare UPIN