MEDICARE: LAURA ROMSDAHL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1659781060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ROMSDAHL

Provider Business Mailing Address
First Line	:	401 N LOOP 336 W
Second Line	:	SUITE C
City	:	CONROE
State	:	TX
Zip	:	77301-1200
Country	:	US
Telephone Number	:	713-878-8500
Fax Number	:	936-242-6254

Provider Business Practice Location Address
First Line	:	401 N LOOP 336 W
Second Line	:	SUITE C
City	:	CONROE
State	:	TX
Zip	:	77301-1200
Country	:	US
Telephone Number	:	713-878-8500
Fax Number	:	936-242-6254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2014
Last Update Date	:	05/07/2014

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