Provider Demographics
NPI:1972136943
Name:LEVALLY, LAURA L
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:LEVALLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:L
Other - Last Name:KEELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1610
Mailing Address - Country:US
Mailing Address - Phone:740-532-3767
Mailing Address - Fax:740-532-3385
Practice Address - Street 1:214 S 4TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1610
Practice Address - Country:US
Practice Address - Phone:740-532-3767
Practice Address - Fax:740-532-3385
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator