Provider Demographics
NPI:1740418805
Name:KOSKI, LAURIE A (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:KOSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:A
Other - Last Name:TOWNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2789 NE RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8348
Mailing Address - Country:US
Mailing Address - Phone:541-647-7626
Mailing Address - Fax:
Practice Address - Street 1:2789 NE RED OAK DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8348
Practice Address - Country:US
Practice Address - Phone:541-647-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL39661041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR156497Medicare PIN