Provider Demographics
NPI:1265596977
Name:STILL, LAURA JANE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JANE
Last Name:STILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3764
Mailing Address - Country:US
Mailing Address - Phone:660-665-0202
Mailing Address - Fax:660-665-2470
Practice Address - Street 1:1001 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3764
Practice Address - Country:US
Practice Address - Phone:660-665-0202
Practice Address - Fax:660-665-2470
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0044431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical