Provider Demographics
NPI:1669149993
Name:KLUCK, LAURA
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:KLUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:LABAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:290 HAVERFORD DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7233
Mailing Address - Country:US
Mailing Address - Phone:570-335-7244
Mailing Address - Fax:
Practice Address - Street 1:335 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3808
Practice Address - Country:US
Practice Address - Phone:570-825-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013670101YP2500X, 101YP2500X
PAPCO13670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional