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General NPI Number Information
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NPI Number | 1396108445
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Entity Type | Individual
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Provider Name | LARA WALDENMAIER
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Gender | Female
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 221 E 320TH ST
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City | WILLOWICK
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State | OH
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Zip | 44095-3539
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Country | US
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Telephone | 440-742-4656
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Fax | 440-792-5081
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Provider Business Mailing Address
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Address Line | 221 E 320TH ST
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City | WILLOWICK
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State | OH
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Zip | 44095-3539
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Country | US
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Telephone | 440-742-4656
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Fax | 440-792-5081
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | E.0008228
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License Number State | OH
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