Provider Demographics
NPI:1205694247
Name:HAACK, LAUREN LEIGH
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEIGH
Last Name:HAACK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 ALLVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2017
Mailing Address - Country:US
Mailing Address - Phone:614-365-0124
Mailing Address - Fax:
Practice Address - Street 1:3990 JOHN R ST STE 615
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2018
Practice Address - Country:US
Practice Address - Phone:313-745-4195
Practice Address - Fax:313-993-8669
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program