Healthcare Provider Details

I. General information

NPI: 1629290861
Provider Name (Legal Business Name): LUANNE MARIE LARUE MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 PARK AVE W
MANSFIELD OH
44902-1608
US

IV. Provider business mailing address

208 PENN AVE
BUCYRUS OH
44820-2031
US

V. Phone/Fax

Practice location:
  • Phone: 419-774-5970
  • Fax: 419-524-1852
Mailing address:
  • Phone: 419-774-5970
  • Fax: 419-524-1852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI-0009081
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: