Provider Demographics
NPI:1538175625
Name:VANLANDEGHEM, LAURA (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VANLANDEGHEM
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 S LAPEER RD STE 205
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5084
Mailing Address - Country:US
Mailing Address - Phone:248-891-2255
Mailing Address - Fax:248-969-2299
Practice Address - Street 1:837 S LAPEER RD STE 205
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-5084
Practice Address - Country:US
Practice Address - Phone:248-891-2255
Practice Address - Fax:248-969-2299
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801082635104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G96288083Medicare UPIN