Provider Demographics
NPI:1689218893
Name:URLAUB, STEFANI JIN
Entity Type:Individual
Prefix:
First Name:STEFANI
Middle Name:JIN
Last Name:URLAUB
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 1:235 KEDZIE ST
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4533
Mailing Address - Country:US
Mailing Address - Phone:586-914-0705
Mailing Address - Fax:
Practice Address - Street 1:405 W GREENLAWN AVE STE 200
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2889
Practice Address - Country:US
Practice Address - Phone:248-621-4792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-11-18
Deactivation Date:2019-10-31
Deactivation Code:
Reactivation Date:2019-11-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI83640OtherBCBS