Provider Demographics
NPI:1629290861
Name:LARUE, LUANNE MARIE (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:LUANNE
Middle Name:MARIE
Last Name:LARUE
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-2031
Mailing Address - Country:US
Mailing Address - Phone:419-774-5970
Mailing Address - Fax:419-524-1852
Practice Address - Street 1:228 PARK AVE W
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-1608
Practice Address - Country:US
Practice Address - Phone:419-774-5970
Practice Address - Fax:419-524-1852
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0009081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker