Provider Demographics
NPI:1336241439
Name:WHITTAKER, LAURA ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 28TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6931
Mailing Address - Country:US
Mailing Address - Phone:810-987-5300
Mailing Address - Fax:810-985-2150
Practice Address - Street 1:2215 COURT ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4937
Practice Address - Country:US
Practice Address - Phone:810-987-1311
Practice Address - Fax:810-985-2150
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health