1023659570 NPI number — MRS. LAURI RACHELLE BUDZYNSKI LPC

Table of content: MRS. LAURI RACHELLE BUDZYNSKI LPC (NPI 1023659570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023659570 NPI number — MRS. LAURI RACHELLE BUDZYNSKI LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUDZYNSKI
Provider First Name:
LAURI
Provider Middle Name:
RACHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STOLLER
Provider Other First Name:
LAURI
Provider Other Middle Name:
RACHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023659570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7929 N PORT WASHINGTON RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53217-3135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-867-3556
Provider Business Mailing Address Fax Number:
715-256-8324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7929 N PORT WASHINGTON RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53217-3135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-867-3556
Provider Business Practice Location Address Fax Number:
715-256-8324
Provider Enumeration Date:
10/07/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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