Provider Demographics
NPI:1578571964
Name:LAUTERBACH, JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:LAUTERBACH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 243461
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-3461
Mailing Address - Country:US
Mailing Address - Phone:907-242-3801
Mailing Address - Fax:907-646-9784
Practice Address - Street 1:4401 BUSINESS PARK BLVD
Practice Address - Street 2:SUITE 24
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7117
Practice Address - Country:US
Practice Address - Phone:907-242-3801
Practice Address - Fax:907-646-9784
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1781041C0700X
CO9894251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical