Provider Demographics
NPI:1447281209
Name:WHEAR, LAURIE JEAN (LBSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:JEAN
Last Name:WHEAR
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:JEAN
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:715 PYLE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802-4456
Mailing Address - Country:US
Mailing Address - Phone:906-774-0522
Mailing Address - Fax:906-774-1570
Practice Address - Street 1:703 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-1451
Practice Address - Country:US
Practice Address - Phone:906-265-5126
Practice Address - Fax:906-265-5878
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802058739104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MILW058739OtherBCBS OF MI