Individual
LAUREN MICHELLE DEBERTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6191 S 108TH ST STE B, HALES CORNERS, WI 53130-2524
(414) 475-1896
(414) 988-9764
Mailing address
6191 S 108TH ST STE B, HALES CORNERS, WI 53130-2524
(414) 475-1896
(414) 988-9764
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
459-140
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100087705
—
WI
Enumeration date
10/27/2021
Last updated
10/27/2021
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