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NPI Code Detail

MEDICARE: REBECCA SUE LAIRD LPC

MEDICARE:   REBECCA SUE LAIRD  LPC
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
1101YM0800XMental Health Counselor3584-125WI
2101YP2500XProfessional Counselor3584-125WI

General Provider Information

NPI Number : 1730378027
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA SUE LAIRD LPC
Provider Business Mailing Address
First Line : 2800 E ENTERPRISE AVENUE
Second Line : SUITE 18
City : APPLETON
State : WI
Zip : 54913-7889
Country : US
Telephone Number : 920-915-3456
Fax Number : 820-560-4501
Provider Business Practice Location Address
First Line : 2800 E ENTERPRISE AVENUE
Second Line : SUITE 18
City : APPLETON
State : WI
Zip : 54913-7889
Country : US
Telephone Number : 920-915-3456
Fax Number : 820-560-4501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2007
Last Update Date : 05/19/2010

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Directions to “ REBECCA SUE LAIRD LPC” Practice Location

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