Provider Demographics
NPI:1619540747
Name:TORNBERG, LAUREN PAIGE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PAIGE
Last Name:TORNBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-7726
Mailing Address - Country:US
Mailing Address - Phone:810-447-9904
Mailing Address - Fax:
Practice Address - Street 1:8220 MAIN ST
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-7726
Practice Address - Country:US
Practice Address - Phone:810-447-9904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician