MEDICARE: MS. LAUREN ELIZABETH SPOON PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	6301014214	MI

General Provider Information

NPI Number	:	1861686784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN ELIZABETH SPOON PSY.D.

Provider Business Mailing Address
First Line	:	3333 36TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49512-2809
Country	:	US
Telephone Number	:	616-954-3540
Fax Number	:	616-954-3541

Provider Business Practice Location Address
First Line	:	3333 36TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49512-2809
Country	:	US
Telephone Number	:	616-954-3540
Fax Number	:	616-954-3541

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	10/02/2009

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