Provider Demographics
NPI:1467619395
Name:INGRAM, LAURA ANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:ALFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:631 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3871
Mailing Address - Country:US
Mailing Address - Phone:812-332-1262
Mailing Address - Fax:
Practice Address - Street 1:631 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3871
Practice Address - Country:US
Practice Address - Phone:812-332-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health