Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 071007242 | IL |
N | 103TC0700X | Clinical Psychologist | 071007242 | IL |
N | 103G00000X | Clinical Psychologist | PYT0107 | MO |
N | 103TC0700X | Clinical Psychologist | PYT0107 | MO |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | P.6997 | OH |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY00003686 | WA |
N | 103TH0004X | Health Psychologist | PY00003686 | WA |
NPI | 1073581781 |
---|---|
Provider Name | Dr. Laura Middleton |
First Address | Dayton, OH 45404-1815 |
Second Address | Dayton, OH 45404-1815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 12/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0111221 | (05) | OH |