Provider Demographics
NPI:1225365224
Name:MILLER, LAURA ANN (LISWS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LISWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4737
Mailing Address - Country:US
Mailing Address - Phone:419-557-5177
Mailing Address - Fax:419-557-5179
Practice Address - Street 1:335 BUCKEYE BLVD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1423
Practice Address - Country:US
Practice Address - Phone:419-734-2942
Practice Address - Fax:419-734-4922
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00083351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical