Provider Demographics
NPI:1346949583
Name:LAUREL N. WEAVER
Entity Type:Organization
Organization Name:LAUREL N. WEAVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LISW-S
Authorized Official - Phone:419-296-8591
Mailing Address - Street 1:105 VINE ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817-1251
Mailing Address - Country:US
Mailing Address - Phone:419-296-8591
Mailing Address - Fax:419-932-6740
Practice Address - Street 1:105 VINE ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1251
Practice Address - Country:US
Practice Address - Phone:419-296-8591
Practice Address - Fax:419-932-6740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty