Healthcare Provider Details

I. General information

NPI: 1447773965
Provider Name (Legal Business Name): HEATHER LAUDERBACK LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 PULLMAN DR STE 2200
LEWIS CENTER OH
43035-7381
US

IV. Provider business mailing address

7511 TALL PINE DR
LEWIS CENTER OH
43035
US

V. Phone/Fax

Practice location:
  • Phone: 614-688-7076
  • Fax: 614-688-7155
Mailing address:
  • Phone: 614-600-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0008326
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: