Provider Demographics
NPI:1780228270
Name:LOTTHAMMER, LAURA LEE (BCBA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:LOTTHAMMER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:KORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAURA LEE WILCKE
Mailing Address - Street 1:2785 CASON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2843
Mailing Address - Country:US
Mailing Address - Phone:515-220-1661
Mailing Address - Fax:855-696-1392
Practice Address - Street 1:1250 SW STATE ST STE A
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2555
Practice Address - Country:US
Practice Address - Phone:515-220-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098541103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst