Provider Demographics
NPI:1730198268
Name:HONAN, LAURIE GRONER (MSW LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:GRONER
Last Name:HONAN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ELAINE
Other - Last Name:GRONER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:9913-A MAMC ANNEX RAMP 2
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:360-349-9500
Mailing Address - Fax:
Practice Address - Street 1:4480 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473
Practice Address - Country:US
Practice Address - Phone:573-596-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000095061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490615614Medicaid
MO431008405OtherGROUP ID NUMBER