| Doctor Name: | DR. LAURA MIDDLETON |
| NPI Number: | 1073581781 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | PY00003686 |
| Business Practice Address: | 1669 Windham Way Suite B O Fallon, IL - 622693072 |
| Business Phone Number: | 6186222579 |
| Business Fax Number: | 6186248506 |
| Mailing Address: | 18 Laurel Heights Ct, O FALLON |
| State: | IL |
| Postal Code: | 622693170 |
| Phone Number: | 2533598766 |
| Fax Number: | |
| NPI Enumeration Date: | 03/09/2006 |
| NPI Last Update Date: | 07/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | PY00003686 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |