Provider Demographics
NPI:1053794958
Name:KAZIK, LAUREN M (LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:KAZIK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:JUNCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:444 N WESTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-5715
Mailing Address - Country:US
Mailing Address - Phone:920-750-7000
Mailing Address - Fax:920-364-2451
Practice Address - Street 1:444 N WESTHILL BLVD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5715
Practice Address - Country:US
Practice Address - Phone:920-750-7000
Practice Address - Fax:920-364-2451
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6213101YP2500X
WI6213-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1053794958Medicaid