Individual
R. LAWRENCE DEROO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
700 RAY O VAC DR, SUITE 220, MADISON, WI 53711-2479
(608) 276-9191
(608) 276-9144
Mailing address
700 RAY O VAC DR, SUITE 220, MADISON, WI 53711-2479
(608) 276-9191
(608) 276-9144
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2210-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39596200
—
WI
Enumeration date
12/27/2006
Last updated
07/08/2007
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