Provider Demographics
NPI:1003817289
Name:LADUE, LAURA ELLEN (PT, DPT, LIMHP)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELLEN
Last Name:LADUE
Suffix:
Gender:F
Credentials:PT, DPT, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 N COTNER BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1627
Mailing Address - Country:US
Mailing Address - Phone:402-429-5883
Mailing Address - Fax:402-464-5116
Practice Address - Street 1:1543 N COTNER BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-1627
Practice Address - Country:US
Practice Address - Phone:402-429-5883
Practice Address - Fax:402-817-4319
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE169101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1003817289Medicaid
NENA1366OtherMEDICARE PTAN