Provider Demographics
NPI:1043424534
Name:WEIDERMAN, LAUREN ANN (MSW)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ANN
Last Name:WEIDERMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 MORTIMER ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-2228
Mailing Address - Country:US
Mailing Address - Phone:773-431-0588
Mailing Address - Fax:
Practice Address - Street 1:1904 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-8522
Practice Address - Country:US
Practice Address - Phone:269-256-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511185071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical