Provider Demographics
NPI:1457105801
Name:LASKE, COLLEEN
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:LASKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 KAYPAT DR
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:MI
Mailing Address - Zip Code:48628-9613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:759 KAYPAT DR
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:MI
Practice Address - Zip Code:48628-9613
Practice Address - Country:US
Practice Address - Phone:586-533-1887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst