Provider Demographics
NPI:1376729210
Name:GLOVER, LAURA ROSE (PLCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ROSE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 WOOD LAKE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-5725
Mailing Address - Country:US
Mailing Address - Phone:573-642-5345
Mailing Address - Fax:573-642-5162
Practice Address - Street 1:8548 JADE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65262
Practice Address - Country:US
Practice Address - Phone:573-642-5345
Practice Address - Fax:573-642-5162
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070326071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical