Provider Demographics
NPI:1548763071
Name:LUDA, LAURIE ANNE
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:LUDA
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 1:5295 ROLLING AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3206
Mailing Address - Country:US
Mailing Address - Phone:440-506-5874
Mailing Address - Fax:
Practice Address - Street 1:5295 ROLLING AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3206
Practice Address - Country:US
Practice Address - Phone:440-506-5874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty