MEDICARE: MS. LINDA LAUFFENBERGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	S0004550	OH

General Provider Information

NPI Number	:	1477544328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA LAUFFENBERGER

Provider Business Mailing Address
First Line	:	1345 N FOUNTAIN BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-1422
Country	:	US
Telephone Number	:	937-399-9500
Fax Number	:	937-399-2701

Provider Business Practice Location Address
First Line	:	1345 N FOUNTAIN BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-1422
Country	:	US
Telephone Number	:	937-399-9500
Fax Number	:	937-399-2701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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