Provider Demographics
NPI:1316148828
Name:FROST, LAURIE ANNE (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:ANNE
Last Name:FROST
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SOUTH BEDFORD STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3688
Mailing Address - Country:US
Mailing Address - Phone:608-256-6570
Mailing Address - Fax:
Practice Address - Street 1:222 SOUTH BEDFORD STREET
Practice Address - Street 2:SUITE E
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3688
Practice Address - Country:US
Practice Address - Phone:608-256-6570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI4334-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health