Provider Demographics
NPI:1639451370
Name:ANDERSON, LAURA ELINOR (LMSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELINOR
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 JERSEY RIDGE RD APT 710
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2281
Mailing Address - Country:US
Mailing Address - Phone:507-430-1399
Mailing Address - Fax:
Practice Address - Street 1:2800 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2012
Practice Address - Country:US
Practice Address - Phone:563-445-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007791104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker