Healthcare Provider Details

I. General information

NPI: 1295355147
Provider Name (Legal Business Name): LAUREN PIETRYGA LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LAUREN PHELPS

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 02/06/2024
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 UNIVERSITY AVE
FLINT MI
48504-6208
US

IV. Provider business mailing address

1420 UNIVERSITY AVE
FLINT MI
48504-6208
US

V. Phone/Fax

Practice location:
  • Phone: 810-238-0475
  • Fax:
Mailing address:
  • Phone: 810-238-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851117276
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: