Provider Demographics
NPI:1639191018
Name:HOWARD-BOARDMAN, LAUREL (MSSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:
Last Name:HOWARD-BOARDMAN
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6385 FIRELANE 8
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-9746
Mailing Address - Country:US
Mailing Address - Phone:920-739-9230
Mailing Address - Fax:
Practice Address - Street 1:W6385 FIRELANE 8
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-9746
Practice Address - Country:US
Practice Address - Phone:920-739-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7294-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical