Provider Demographics
NPI:1477836047
Name:STARRETT, LAURA ANNE (LSW, CDCIII)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:STARRETT
Suffix:
Gender:F
Credentials:LSW, CDCIII
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANNE
Other - Last Name:ROOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW,CDCIII
Mailing Address - Street 1:1518 STATE ROUTE 15
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-9633
Mailing Address - Country:US
Mailing Address - Phone:419-636-1263
Mailing Address - Fax:
Practice Address - Street 1:600 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9038
Practice Address - Country:US
Practice Address - Phone:419-599-1660
Practice Address - Fax:419-592-8336
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH981129101YA0400X
OHS.0030740104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)