Individual provider Active NPI

Laura S Middleton, PH.D.

  • Clinical Child & Adolescent Psychologist
  • Dayton, OH
National Provider Identifier
1073581781
Registry record updated Oct 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
P.6997 Issued in OH
Practice address
1 Childrens PLZ
Dayton, OH 45404-1815
Phone
(937) 641-3401
Fax
(937) 641-3066
NPI assigned
Mar 9, 2006
Last updated
Oct 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071007242 IL
Clinical Psychologist 103TC0700X PYT0107 MO
Clinical Child & Adolescent Psychologist 103TC2200X P.6997 OH Primary
Clinical Child & Adolescent Psychologist 103TC2200X PY00003686 WA
Health Psychologist 103TH0004X PY00003686 WA

Addresses

Primary practice location

1 Childrens PLZ
Dayton, OH 45404-1815

Mailing address

PO Box 933421
Cleveland, OH 44193-0039
Phone (937) 641-3000

Other identifiers 1

IdentifierTypeStateIssuer
0111221MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210112002803 OH Practitioner - Clinical Psychologist 2860554573 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
071007242ILMDClinical Psychologist
PYT0107MOMDClinical Psychologist
PY00003686WAMDHealth Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dayton Children's Hospital CurrentSince Dec 1, 2020 Accepting new patients
Dayton Children's Hospital Clinical Child & Adolescent CurrentSince Dec 1, 2020 Accepting new patients

Locations

1 Childrens Plz
Dayton, OH 45404
Phone (937) 641-3600

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697328000000",
    "number": "1073581781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933421",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930039",
            "telephone_number": "937-641-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PLZ",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454041815",
            "telephone_number": "937-641-3401",
            "fax_number": "937-641-3066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIDDLETON",
        "first_name": "LAURA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-09",
        "last_updated": "2023-10-15",
        "certification_date": "2023-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071007242",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "PYT0107",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "OH",
            "license": "P.6997",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "WA",
            "license": "PY00003686",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "WA",
            "license": "PY00003686",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0111221",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.