Individual
LAURA L FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 353-8978
(319) 384-8843
Mailing address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 353-8978
(319) 384-8843
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
001276
IA
103TC0700X
Clinical Psychologist
316
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0492099
—
MT
Enumeration date
05/22/2007
Last updated
10/03/2012
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