Provider Demographics
NPI:1942669346
Name:EASTMAN, LAURIE L (LCSW, SAC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:L
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:LCSW, SAC
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:L
Other - Last Name:MARQUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:903 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2970
Mailing Address - Country:US
Mailing Address - Phone:608-756-6530
Mailing Address - Fax:608-756-6564
Practice Address - Street 1:903 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2970
Practice Address - Country:US
Practice Address - Phone:608-756-6530
Practice Address - Fax:608-756-6564
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16306-131101YA0400X
WI7805-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1942669346OtherDEANHEALTH PLAN
WI1942669346Medicaid
WI701839OtherMERCYCARE INSURANCE
WI000084908-K400277773OtherWI MEDICARE
WI1942669346OtherBCBSWI