Provider Demographics
NPI:1194081430
Name:HARDIN, LAURIE SHOGREN (LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:SHOGREN
Last Name:HARDIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1219
Mailing Address - Country:US
Mailing Address - Phone:502-777-4380
Mailing Address - Fax:
Practice Address - Street 1:1409 FALCON DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1219
Practice Address - Country:US
Practice Address - Phone:502-777-4380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical