Provider Demographics
NPI:1801814488
Name:MUNROE, LAURA CHRISTINE (MSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CHRISTINE
Last Name:MUNROE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S TREVINO DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-3624
Mailing Address - Country:US
Mailing Address - Phone:719-251-5432
Mailing Address - Fax:719-547-4855
Practice Address - Street 1:434 S CONQUISTADOR AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1861
Practice Address - Country:US
Practice Address - Phone:719-251-5432
Practice Address - Fax:719-547-4855
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA100711Medicare PIN