Provider Demographics
NPI:1912542895
Name:VAN LANEN, CORRIN ELIZABETH
Entity Type:Individual
Prefix:
First Name:CORRIN
Middle Name:ELIZABETH
Last Name:VAN LANEN
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 1:127 N FRANKLIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-1948
Mailing Address - Country:US
Mailing Address - Phone:414-310-0365
Mailing Address - Fax:
Practice Address - Street 1:127 N FRANKLIN ST STE 207
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1948
Practice Address - Country:US
Practice Address - Phone:262-235-4385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0501216101Y00000X
WI10299125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor