Provider Demographics
NPI:1356494900
Name:ZIEBARTH, LAURA LOEFFLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LOEFFLER
Last Name:ZIEBARTH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4717 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9318
Mailing Address - Country:US
Mailing Address - Phone:269-429-4694
Mailing Address - Fax:
Practice Address - Street 1:3408 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8628
Practice Address - Country:US
Practice Address - Phone:269-428-4789
Practice Address - Fax:269-408-0084
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008479101YP2500X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION77560Medicare ID - Type UnspecifiedMEDICARE ID NUMBER