Provider Demographics
NPI:1013497122
Name:ZAJKOWSKI, LAURA SUSAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:SUSAN
Last Name:ZAJKOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W69N410 FOXPOINTE AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2230
Mailing Address - Country:US
Mailing Address - Phone:847-791-1782
Mailing Address - Fax:
Practice Address - Street 1:W69N410 FOXPOINTE AVE
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2230
Practice Address - Country:US
Practice Address - Phone:847-791-1782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490142981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical