Provider Demographics
NPI:1326274838
Name:EWALD, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:EWALD
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 1:9213 WILLARD RD
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48746-9311
Mailing Address - Country:US
Mailing Address - Phone:989-871-3735
Mailing Address - Fax:
Practice Address - Street 1:9213 WILLARD RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:MI
Practice Address - Zip Code:48746-9311
Practice Address - Country:US
Practice Address - Phone:989-871-3735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)