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General NPI Number Information
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NPI Number | 1407804842
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Entity Type | Individual
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Provider Name | LAURA M. BLACKWELL LISW
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 4930 N HOLLAND SYLVANIA RD STE E
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City | SYLVANIA
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State | OH
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Zip | 43560
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Country | US
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Telephone | 419-973-7029
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 60413
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City | ROSSFORD
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State | OH
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Zip | 43460-0413
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Country | US
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Telephone | 419-973-7029
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-0007485
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License Number State | OH
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