Healthcare Provider Details

I. General information

NPI: 1568377463
Provider Name (Legal Business Name): LAURA BETH BIWER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15205 MARILYN DR APT 1
ELM GROVE WI
53122-1067
US

IV. Provider business mailing address

1368 S MAIN ST
LAKE MILLS WI
53551-9567
US

V. Phone/Fax

Practice location:
  • Phone: 414-559-8825
  • Fax:
Mailing address:
  • Phone: 262-844-3128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: