Healthcare Provider Details

I. General information

NPI: 1053915223
Provider Name (Legal Business Name): LAUREN ELIZABETH HAUCK M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2020
Last Update Date: 05/16/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

IV. Provider business mailing address

600 W 22ND ST STE 250
OAK BROOK IL
60523-8864
US

V. Phone/Fax

Practice location:
  • Phone: 646-455-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: