Healthcare Provider Details

I. General information

NPI: 1821614942
Provider Name (Legal Business Name): LAURA MARIE REDDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 ARNOLD CT
KOKOMO IN
46902-3702
US

IV. Provider business mailing address

280 S UNION ST
RUSSIAVILLE IN
46979-9106
US

V. Phone/Fax

Practice location:
  • Phone: 765-450-4843
  • Fax:
Mailing address:
  • Phone: 765-210-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: