Healthcare Provider Details

I. General information

NPI: 1720126444
Provider Name (Legal Business Name): LAWRENCE F UGLOW LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 N PORT WASHINGTON RD
MEQUON WI
53092-5585
US

IV. Provider business mailing address

10500 N PORT WASHINGTON RD
MEQUON WI
53092-5585
US

V. Phone/Fax

Practice location:
  • Phone: 262-240-0427
  • Fax: 262-240-0429
Mailing address:
  • Phone: 262-240-0427
  • Fax: 262-240-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number2655-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: