Provider Demographics
NPI:1508543950
Name:JEROME, LAUREN M (CSAC, CSIT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:M
Last Name:JEROME
Suffix:
Gender:F
Credentials:CSAC, CSIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5852
Mailing Address - Country:US
Mailing Address - Phone:920-469-2569
Mailing Address - Fax:920-469-2580
Practice Address - Street 1:2670 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5852
Practice Address - Country:US
Practice Address - Phone:920-469-2569
Practice Address - Fax:920-469-2580
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3029101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)