Provider Demographics
NPI:1689433021
Name:WALL, LAURA E (LSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:WALL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 N BETHLEHEM PIKE STE 104
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2652
Mailing Address - Country:US
Mailing Address - Phone:609-766-5108
Mailing Address - Fax:
Practice Address - Street 1:748 N BETHLEHEM PIKE STE 104
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2652
Practice Address - Country:US
Practice Address - Phone:609-766-5108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138628104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker