Provider Demographics
NPI:1982837290
Name:WILMOT, LAURIE JANE (LCSW, CADCIII)
Entity Type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:JANE
Last Name:WILMOT
Suffix:
Gender:F
Credentials:LCSW, CADCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 NW JACKSONVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2228
Mailing Address - Country:US
Mailing Address - Phone:541-280-1570
Mailing Address - Fax:
Practice Address - Street 1:1345 NW WALL ST STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1967
Practice Address - Country:US
Practice Address - Phone:541-280-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL41051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical