Provider Demographics
NPI:1427105352
Name:LEBLANC, LAURA J
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:J
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 CLARK CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1421
Mailing Address - Country:US
Mailing Address - Phone:773-844-8389
Mailing Address - Fax:773-681-7488
Practice Address - Street 1:727 CLARK CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1421
Practice Address - Country:US
Practice Address - Phone:773-844-8389
Practice Address - Fax:773-681-7488
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490101061041C0700X
WI8521-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical