Provider Demographics
NPI:1396024253
Name:WEVERS, LAURA JOY (MA)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JOY
Last Name:WEVERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:JOY
Other - Last Name:WEVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:11108 ZEALAND AVE N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3594
Mailing Address - Country:US
Mailing Address - Phone:651-726-4940
Mailing Address - Fax:
Practice Address - Street 1:11108 ZEALAND AVE N
Practice Address - Street 2:SUITE 103
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3594
Practice Address - Country:US
Practice Address - Phone:651-726-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health