Healthcare Provider Details

I. General information

NPI: 1841351467
Provider Name (Legal Business Name): LAUREN RUTH UNGAR LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W MICHIGAN AVE
JACKSON MI
49201-1907
US

IV. Provider business mailing address

3155 DOLPH DR
ANN ARBOR MI
48103-2066
US

V. Phone/Fax

Practice location:
  • Phone: 517-783-5334
  • Fax: 517-783-6064
Mailing address:
  • Phone: 734-623-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301010927
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: