Healthcare Provider Details

I. General information

NPI: 1497266399
Provider Name (Legal Business Name): LAURA ALLYSON HENRY BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2359 KNOLLWOOD AVE
YOUNGSTOWN OH
44514-1525
US

IV. Provider business mailing address

238 S MERIDIAN RD
YOUNGSTOWN OH
44509-2925
US

V. Phone/Fax

Practice location:
  • Phone: 216-260-1405
  • Fax: 330-632-8823
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: