Provider Demographics
NPI:1982338448
Name:LAURA WEATHERBY PLLC
Entity Type:Organization
Organization Name:LAURA WEATHERBY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:WEATHERBY
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:320-220-4046
Mailing Address - Street 1:1323 KANDIYOHI AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-2956
Mailing Address - Country:US
Mailing Address - Phone:320-220-4046
Mailing Address - Fax:
Practice Address - Street 1:800 E DEPUE AVE STE B
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1388
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty