Healthcare Provider Details

I. General information

NPI: 1700456761
Provider Name (Legal Business Name): LAURIE WESELY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SCHWEGLER DR RM 2100
LAWRENCE KS
66045-7538
US

IV. Provider business mailing address

1200 SCHWEGLER DR RM 2100
LAWRENCE KS
66045-7538
US

V. Phone/Fax

Practice location:
  • Phone: 785-864-2277
  • Fax: 785-864-2721
Mailing address:
  • Phone: 785-864-2277
  • Fax: 785-864-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1741
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: