Provider Information for 1134983455
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Mrs. LAURIE JANSEN GRAY LCSW
Sex: Female
NPI: 1134983455
Last Updated: 2024-02-07
Certification Date: 2024-02-07
Certification Date: 2024-02-07
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1134983455 | ||||||||
| Enumeration Date | 2024-02-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1401 MERGANSER BLVD SWANSEA, IL 62226-8544 United States Phone: 618-806-4243 | Fax: | ||||||||
| Primary Practice Address | 1401 MERGANSER BLVD SWANSEA, IL 62226-8544 United States Phone: 618-806-4243 | Fax: | ||||||||
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