Basic Information
| Provider Information | |||||||||
| NPI: | 1558576215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAUENHAUER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 N 12TH ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532331308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147734312 | ||||||||
| FaxNumber: | 4142195422 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 N 12TH ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147734312 | ||||||||
| FaxNumber: | 4142195422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 0116017605 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084P0800X | 56293 | WI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 100018323 | 05 | WI | MEDICAID |