Provider Demographics
NPI:1942707237
Name:QUETSCH, LAUREN BORDUIN (PHD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BORDUIN
Last Name:QUETSCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 N CAMPUS DRIVE, MEMORIAL HALL 216
Mailing Address - Street 2:UNIVERSITY OF ARKANSAS, DEPARTMENT OF PSYCH
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701
Mailing Address - Country:US
Mailing Address - Phone:573-356-5902
Mailing Address - Fax:
Practice Address - Street 1:480 N CAMPUS DRIVE, UNIVERSITY OF ARKANSAS
Practice Address - Street 2:MEMORIAL HALL 111, PSYCHOLOGICAL CLINIC
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-575-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202125103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program