Provider Demographics
NPI:1912444969
Name:SASSO, LAURIE JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:JEAN
Last Name:SASSO
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 1:1405 CAPITOL DR STE C
Mailing Address - Street 2:NUMBER 172
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-6930
Mailing Address - Country:US
Mailing Address - Phone:262-424-2445
Mailing Address - Fax:262-538-0621
Practice Address - Street 1:1405 CAPITOL DR STE C
Practice Address - Street 2:NUMBER 172
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-6930
Practice Address - Country:US
Practice Address - Phone:262-424-2445
Practice Address - Fax:262-538-0621
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3573-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical