LAURA J PANKOW OD Social Worker License verification

Business Entity

INACTIVE

License Type

Social Worker

Description

LICENSED CLINICAL SOCIAL WORKER

License Number

149007165

License Status

INACTIVE

Business

First Name

LAURA

Middle

Last Name

PANKOW

Suffix

Business Name

LAURA J PANKOW OD

Original Issue Date

07/19/1996

Effective Date

09/02/2009

Expiration Date

11/30/2011

City

SOUTH BEND

State

Zip

46615

County

INDIANA

Specialty/Qualifier

MASTERS

Ever Disciplined

LastModifiedDate

09/07/2011