Provider Demographics
NPI:1154858660
Name:MCCLURE, LAURA MICHELLE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:MCCLURE
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 1:3 CUSUMANO PROFESSIONAL PLAZA DR STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6736
Mailing Address - Country:US
Mailing Address - Phone:314-627-0313
Mailing Address - Fax:
Practice Address - Street 1:1136 N DESLOGE DR STE B
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-2900
Practice Address - Country:US
Practice Address - Phone:314-520-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical