Provider Demographics
NPI:1548797848
Name:MIDKIFF, LAUREN ELISE (LLBSW)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ELISE
Last Name:MIDKIFF
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:MRS
Other - First Name:LAUREN
Other - Middle Name:ELISE
Other - Last Name:KERLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLBSW
Mailing Address - Street 1:356 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:MI
Mailing Address - Zip Code:49038
Mailing Address - Country:US
Mailing Address - Phone:269-925-0585
Mailing Address - Fax:
Practice Address - Street 1:1485 M-139
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022
Practice Address - Country:US
Practice Address - Phone:269-925-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802088625104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker