Provider Demographics
NPI:1336689074
Name:BLANEY, LAURA RUTH (MSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:RUTH
Last Name:BLANEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 N TISDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-2009
Mailing Address - Country:US
Mailing Address - Phone:503-277-9951
Mailing Address - Fax:
Practice Address - Street 1:360 COLLEGE MEADOWS DR
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-9153
Practice Address - Country:US
Practice Address - Phone:307-673-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-11491041C0700X
ORTHW1676172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker