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General NPI Number Information
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NPI Number | 1982338448
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Entity Type | Organization
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Legal Business Name | LAURA WEATHERBY PLLC
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 800 E DEPUE AVE STE B
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City | OLIVIA
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State | MN
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Zip | 56277-1388
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 1323 KANDIYOHI AVE SW
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City | WILLMAR
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State | MN
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Zip | 56201-2956
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Country | US
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Telephone | 320-220-4046
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. LAURA BETH WEATHERBY
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Credential | LP
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Telephone | 320-220-4046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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