Basic Information
| Provider Information | |||||||||
| NPI: | 1336419407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OSBORN-COFFEY | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MSW, LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5400 DUPONT CIRCLE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MILFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135767700 | ||||||||
| FaxNumber: | 5135761020 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 HOSPITAL DRIVE | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | BATAVIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137320870 | ||||||||
| FaxNumber: | 5137320873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2012 | ||||||||
| LastUpdateDate: | 01/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | I4163 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.