Provider Demographics
NPI:1902531049
Name:LAUE, SUSAN CAROLINE (LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROLINE
Last Name:LAUE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-1228
Mailing Address - Country:US
Mailing Address - Phone:171-233-0376
Mailing Address - Fax:
Practice Address - Street 1:912 OKOBOJI AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IA
Practice Address - Zip Code:51351-1515
Practice Address - Country:US
Practice Address - Phone:712-339-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114978101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health