Provider Demographics
NPI:1689491573
Name:WEATHERHEAD, LAURIE LYNN
Entity type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:LYNN
Last Name:WEATHERHEAD
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 1:8 NORTHERN RD
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2040
Mailing Address - Country:US
Mailing Address - Phone:207-764-4756
Mailing Address - Fax:207-540-1091
Practice Address - Street 1:8 NORTHERN RD
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2040
Practice Address - Country:US
Practice Address - Phone:207-764-4756
Practice Address - Fax:207-540-1091
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS18254104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker