Provider Demographics
NPI:1114506995
Name:MANN, LAURA (SWA, CDCA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:SWA, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 GIDDINGS RD
Mailing Address - Street 2:
Mailing Address - City:ROOTSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44272-9745
Mailing Address - Country:US
Mailing Address - Phone:330-322-4311
Mailing Address - Fax:
Practice Address - Street 1:6007 GIDDINGS RD
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272-9745
Practice Address - Country:US
Practice Address - Phone:330-322-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH090001101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)