Provider Demographics
NPI:1023017365
Name:REIBER, LAURA GRACE (LICSW ACSW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:GRACE
Last Name:REIBER
Suffix:
Gender:F
Credentials:LICSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 STEVENS DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-3360
Mailing Address - Country:US
Mailing Address - Phone:509-876-4009
Mailing Address - Fax:509-946-1432
Practice Address - Street 1:2330 EASTGATE ST STE 207
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1559
Practice Address - Country:US
Practice Address - Phone:509-876-4009
Practice Address - Fax:509-946-1430
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000078251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8807191Medicare PIN