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General NPI Number Information
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NPI Number | 1235148958
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Entity Type | Individual
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Provider Name | LAURA M MACKNER PH.D
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/19/2025
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Provider Practice Location Address
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Address Line | 9734 JUG ST. NW PBJ CONNECTIONS
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City | PATASKALA
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State | OH
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Zip | 43062
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Country | US
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Telephone | 740-924-7543
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Fax | 740-924-2002
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Provider Business Mailing Address
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Address Line | 335 NORTHRIDGE RD
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City | COLUMBUS
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State | OH
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Zip | 43214-3327
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Country | US
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Telephone | 614-596-8574
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5812
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P.5812
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License Number State | OH
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