Healthcare Provider Details

I. General information

NPI: 1831675453
Provider Name (Legal Business Name): LAURA HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 09/29/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E EXCHANGE ST FL 6
AKRON OH
44308-1541
US

IV. Provider business mailing address

110 WURST CT
ELYRIA OH
44035-5611
US

V. Phone/Fax

Practice location:
  • Phone: 234-334-3293
  • Fax:
Mailing address:
  • Phone: 440-865-6623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: