Provider Demographics
NPI:1487881173
Name:LAUX-LUDWIG, JENNIFER LOU
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOU
Last Name:LAUX-LUDWIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:LUDWIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:854 WASHINGTON AVE
Mailing Address - Street 2:SUITE #330
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7144
Mailing Address - Country:US
Mailing Address - Phone:616-355-3926
Mailing Address - Fax:
Practice Address - Street 1:854 WASHINGTON AVE
Practice Address - Street 2:SUITE #330
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7144
Practice Address - Country:US
Practice Address - Phone:616-355-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011262103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent