Provider Demographics
NPI:1922351451
Name:LAUER, SHADEE E
Entity Type:Individual
Prefix:
First Name:SHADEE
Middle Name:E
Last Name:LAUER
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 1:2308 GANDERT AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-9607
Mailing Address - Country:US
Mailing Address - Phone:505-219-1125
Mailing Address - Fax:
Practice Address - Street 1:2632 PENNSYLVANIA ST NE STE E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3650
Practice Address - Country:US
Practice Address - Phone:505-559-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0142831101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health