Healthcare Provider Details

I. General information

NPI: 1558070037
Provider Name (Legal Business Name): ELLEN M LAUBACHER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN M LAUBACHER LMSW

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15146 16TH AVE
MARNE MI
49435-9605
US

IV. Provider business mailing address

15146 16TH AVE
MARNE MI
49435-9605
US

V. Phone/Fax

Practice location:
  • Phone: 616-520-9074
  • Fax:
Mailing address:
  • Phone: 616-520-9074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: