Provider Demographics
NPI:1770664781
Name:WEATHERBY, LAURA BETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:BETH
Last Name:WEATHERBY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 KANDIYOHI AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3833
Mailing Address - Country:US
Mailing Address - Phone:320-235-4613
Mailing Address - Fax:320-231-9140
Practice Address - Street 1:1125 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-0787
Practice Address - Country:US
Practice Address - Phone:320-235-4613
Practice Address - Fax:320-231-9140
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR167040-0163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No163W00000XNursing Service ProvidersRegistered Nurse