Provider Demographics
NPI:1730378027
Name:LAIRD, REBECCA SUE (LPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:LAIRD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E ENTERPRISE AVENUE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7889
Mailing Address - Country:US
Mailing Address - Phone:920-915-3456
Mailing Address - Fax:820-560-4501
Practice Address - Street 1:2800 E ENTERPRISE AVENUE
Practice Address - Street 2:SUITE 18
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7889
Practice Address - Country:US
Practice Address - Phone:920-915-3456
Practice Address - Fax:820-560-4501
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3584-125101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health