Healthcare Provider Details

I. General information

NPI: 1366936700
Provider Name (Legal Business Name): EMILY M LAABS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 E MAIN ST STE A
COLUMBUS OH
43215-5349
US

IV. Provider business mailing address

DEPT. 781625 PO BOX 78000
DETROIT MI
48278-1625
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-8055
  • Fax: 614-355-8056
Mailing address:
  • Phone: 614-355-8004
  • Fax: 614-355-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1802055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: