MEDICARE: LAURA WEUBBE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0-16-7020

General Provider Information

NPI Number	:	1629432638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA WEUBBE

Provider Business Mailing Address
First Line	:	214 ESTATES DR
Second Line	:	SUITE A
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-2353
Country	:	US
Telephone Number	:	916-749-4646
Fax Number	:	916-749-4520

Provider Business Practice Location Address
First Line	:	214 ESTATES DR
Second Line	:	SUITE A
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-2353
Country	:	US
Telephone Number	:	916-749-4646
Fax Number	:	916-749-4520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2016
Last Update Date	:	11/29/2016

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Directions to “ LAURA WEUBBE ” Practice Location

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