Healthcare Provider Details

I. General information

NPI: 1326214792
Provider Name (Legal Business Name): LAURA ANN OCHTRUP M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 W LINCOLN AVE
WEST ALLIS WI
53227-1133
US

IV. Provider business mailing address

11101 W LINCOLN AVE
WEST ALLIS WI
53227-1133
US

V. Phone/Fax

Practice location:
  • Phone: 414-203-4469
  • Fax: 414-328-3737
Mailing address:
  • Phone: 414-203-4469
  • Fax: 414-328-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6985-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: