Healthcare Provider Details

I. General information

NPI: 1154671477
Provider Name (Legal Business Name): LAURIE J LAWRENZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S 8TH ST # G20
SHEBOYGAN WI
53081
US

IV. Provider business mailing address

615 S 8TH ST # G20
SHEBOYGAN WI
53081-4463
US

V. Phone/Fax

Practice location:
  • Phone: 920-226-9599
  • Fax: 920-783-8422
Mailing address:
  • Phone: 920-226-9599
  • Fax: 920-783-8422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5458-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10688-120
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: