Provider Demographics
NPI:1457408809
Name:LAUDER, KRISTEN ANN (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:LAUDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180680
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-0680
Mailing Address - Country:US
Mailing Address - Phone:414-453-8380
Mailing Address - Fax:414-443-1635
Practice Address - Street 1:1011 N MAYFAIR RD
Practice Address - Street 2:304
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3431
Practice Address - Country:US
Practice Address - Phone:414-453-8380
Practice Address - Fax:414-443-1635
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7088-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40910800Medicaid
WI40910800Medicaid