Healthcare Provider Details

I. General information

NPI: 1073328639
Provider Name (Legal Business Name): LAURA EMILY WOODWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 WAKARUSA DR STE 102
LAWRENCE KS
66047-2082
US

IV. Provider business mailing address

829 PRESCOTT DR
LAWRENCE KS
66049-3662
US

V. Phone/Fax

Practice location:
  • Phone: 785-371-4921
  • Fax:
Mailing address:
  • Phone: 785-218-3762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLMLP03401-T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: