Provider Demographics
NPI:1922327642
Name:LAURIE A. FROST, PHD, LLC
Entity Type:Organization
Organization Name:LAURIE A. FROST, PHD, LLC
Other - Org Name:ISTHMUS PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-256-6570
Mailing Address - Street 1:222 S BEDFORD ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3688
Mailing Address - Country:US
Mailing Address - Phone:608-256-6570
Mailing Address - Fax:
Practice Address - Street 1:222 S BEDFORD ST
Practice Address - Street 2:SUITE E
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3688
Practice Address - Country:US
Practice Address - Phone:608-256-6570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4334-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health