Healthcare Provider Details

I. General information

NPI: 1083577662
Provider Name (Legal Business Name): MS. LAURIE DUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 S BRANNON STAND RD
DOTHAN AL
36305-7005
US

IV. Provider business mailing address

104 PETUNIA DR
TAYLOR AL
36301-6144
US

V. Phone/Fax

Practice location:
  • Phone: 334-618-6809
  • Fax:
Mailing address:
  • Phone: 334-479-3899
  • Fax: 334-479-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-477916
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: