Provider Demographics
NPI:1487075354
Name:DREUTH, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DREUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N TOWER RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1930
Mailing Address - Country:US
Mailing Address - Phone:618-924-7476
Mailing Address - Fax:
Practice Address - Street 1:105 N TOWER RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1930
Practice Address - Country:US
Practice Address - Phone:618-924-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490143981041C0700X
TN11141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical