Provider Demographics
NPI:1295428985
Name:SANDTVEIT, LAUREN (LLMSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SANDTVEIT
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 MAYAPPLE LN APT 12
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-7342
Mailing Address - Country:US
Mailing Address - Phone:616-894-2692
Mailing Address - Fax:
Practice Address - Street 1:437 FERN AVE STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3970
Practice Address - Country:US
Practice Address - Phone:517-247-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511159021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical