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General NPI Number Information
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NPI Number | 1992696025
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Entity Type | Individual
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Provider Name | LAURE WIETHOFF ED.S
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Gender |
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 815 N STATE ROAD 29
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City | MICHIGANTOWN
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State | IN
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Zip | 46057-9616
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Country | US
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Telephone | 765-249-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 6192 CHATSWORTH DR
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City | WHITESTOWN
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State | IN
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Zip | 46075-4484
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Country | US
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Telephone | 630-956-3722
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 10183770
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License Number State | IN
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