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Individual

MRS. LAURA DENISE LEEMASTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW, ACSW

Contact information

Practice address
4004 CAMPBELL, VALPARAISO, IN 46385
(219) 462-9000
(219) 462-9000
Mailing address
815 MAIN ST., SUITE 1D, ST. JOSEPH, MI 49085
(269) 982-4055
(219) 462-9000

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
34003981A
IN
1041C0700X
Clinical Social Worker
Primary
6801090052
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000219941
BLUE CROSSBLUE SHIELD
IN
01
11490947
CAQH LAURA SMITH/LEEMASTER
Enumeration date
02/12/2007
Last updated
12/16/2008
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