Provider Demographics
NPI:1518609593
Name:UTTKE, LAUREN OLETA
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:OLETA
Last Name:UTTKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:OLETA
Other - Last Name:BEARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2424 COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7505
Mailing Address - Country:US
Mailing Address - Phone:252-557-0444
Mailing Address - Fax:
Practice Address - Street 1:503 SPIRO CT
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28574-6012
Practice Address - Country:US
Practice Address - Phone:803-429-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical