Healthcare Provider Details

I. General information

NPI: 1417461872
Provider Name (Legal Business Name): LAUREN LIEB LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7322 W RAWSON AVE
FRANKLIN WI
53132-8117
US

IV. Provider business mailing address

2532 N 124TH ST APT 251
WAUWATOSA WI
53226-1030
US

V. Phone/Fax

Practice location:
  • Phone: 414-433-9010
  • Fax:
Mailing address:
  • Phone: 262-227-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number59804
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9159-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: