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General NPI Number Information
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NPI Number | 1427105352
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Entity Type | Individual
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Provider Name | MS. LAURA J LEBLANC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 02/05/2017
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Provider Practice Location Address
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Address Line | 727 CLARK CT
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City | MADISON
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State | WI
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Zip | 53715-1421
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Country | US
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Telephone | 773-844-8389
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Fax | 773-681-7488
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Provider Business Mailing Address
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Address Line | 727 CLARK CT
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City | MADISON
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State | WI
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Zip | 53715-1421
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Country | US
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Telephone | 773-844-8389
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Fax | 773-681-7488
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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 | 149010106
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8521-123
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License Number State | WI
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