1043683972 NPI number — LAURA A. RAHN, LLC

Table of content: (NPI 1043683972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043683972 NPI number — LAURA A. RAHN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAURA A. RAHN, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043683972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
S16W32615 LUTERBACH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELAFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53018-3368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-732-7187
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3215 GOLF RD
Provider Second Line Business Practice Location Address:
STE 173
Provider Business Practice Location Address City Name:
DELAFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53018-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-732-7187
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RAHN
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
414-732-7187

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  7372-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1477733848 . This is a "NPI-INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43719900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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