Provider Demographics
NPI:1700229564
Name:LAZRIA PRICE
Entity Type:Organization
Organization Name:LAZRIA PRICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SAC-IT
Authorized Official - Prefix:
Authorized Official - First Name:LAZRIA
Authorized Official - Middle Name:TRINETTE
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-497-3445
Mailing Address - Street 1:4001 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2530
Mailing Address - Country:US
Mailing Address - Phone:414-759-6377
Mailing Address - Fax:
Practice Address - Street 1:4001 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2530
Practice Address - Country:US
Practice Address - Phone:414-455-3879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16859251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health