Provider Demographics
NPI:1124559034
Name:MEYER, LAURA (CADC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1317
Mailing Address - Country:US
Mailing Address - Phone:712-234-2300
Mailing Address - Fax:712-234-2399
Practice Address - Street 1:3500 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-3203
Practice Address - Country:US
Practice Address - Phone:712-234-2382
Practice Address - Fax:712-234-2395
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13075101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)