Provider Demographics
NPI:1790074201
Name:SUMINSKI, LAURA (MSE, NCC, SAC-IT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SUMINSKI
Suffix:
Gender:F
Credentials:MSE, NCC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 APPLEGATE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3184
Mailing Address - Country:US
Mailing Address - Phone:608-221-1500
Mailing Address - Fax:608-221-1515
Practice Address - Street 1:1334 APPLEGATE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-3184
Practice Address - Country:US
Practice Address - Phone:608-221-1500
Practice Address - Fax:608-221-1515
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16278-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)