Provider Demographics
NPI:1538668041
Name:SQUIER, LAURA ELLEN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:SQUIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 TRADEWINDS DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-3559
Mailing Address - Country:US
Mailing Address - Phone:344-941-9370
Mailing Address - Fax:
Practice Address - Street 1:9910 TRADEWINDS DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3559
Practice Address - Country:US
Practice Address - Phone:434-941-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-42326103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst