Provider Demographics
NPI:1578576971
Name:KRAUTH, LAURIE D (LLP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:D
Last Name:KRAUTH
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 POWELL AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6467
Mailing Address - Country:US
Mailing Address - Phone:734-741-8862
Mailing Address - Fax:734-741-8862
Practice Address - Street 1:2002 HOGBACK RD
Practice Address - Street 2:SUITE 15
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9736
Practice Address - Country:US
Practice Address - Phone:734-973-3100
Practice Address - Fax:734-973-3100
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health