Healthcare Provider Details

I. General information

NPI: 1376166470
Provider Name (Legal Business Name): LAUREN KEOUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 PLYMOUTH RD STE 104
ANN ARBOR MI
48105-9557
US

IV. Provider business mailing address

9905 S HAZEL ST
SOUTH LYON MI
48178-9007
US

V. Phone/Fax

Practice location:
  • Phone: 734-531-8044
  • Fax:
Mailing address:
  • Phone: 734-531-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801100635
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: