Provider Demographics
NPI:1326600354
Name:LYDDON, LAURA MARIE (LSCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:LYDDON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 LOCKETT LN
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:KS
Mailing Address - Zip Code:66535-4004
Mailing Address - Country:US
Mailing Address - Phone:620-482-0315
Mailing Address - Fax:
Practice Address - Street 1:1623 POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-4148
Practice Address - Country:US
Practice Address - Phone:785-369-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS056601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical