Basic Information
| Provider Information | |||||||||
| NPI: | 1326214792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OCHTRUP | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11101 W LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532271133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142034469 | ||||||||
| FaxNumber: | 4143283737 | ||||||||
| Practice Location | |||||||||
| Address1: | 11101 W LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532271133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142034469 | ||||||||
| FaxNumber: | 4143283737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2008 | ||||||||
| LastUpdateDate: | 05/05/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6985-123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1053329581 | 01 | NPI THROUGH MY EMPLOYER ROGERS MEMORIAL HOSPITAL | OTHER | 40928500 | 05 | WI | MEDICAID |