Provider Demographics
NPI:1689970162
Name:FLEMING, LAUREN CHRISTEN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CHRISTEN
Last Name:FLEMING
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 1:1501 WHITETAIL RUN
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-7917
Mailing Address - Country:US
Mailing Address - Phone:217-433-3746
Mailing Address - Fax:
Practice Address - Street 1:3271 NORTH ST
Practice Address - Street 2:
Practice Address - City:EAST TROY
Practice Address - State:WI
Practice Address - Zip Code:53120-1147
Practice Address - Country:US
Practice Address - Phone:262-642-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11396-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist