Provider Demographics
NPI:1033410519
Name:MATHIESEN, LAUREL ANNE
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANNE
Last Name:MATHIESEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:ANNE
Other - Last Name:RIGGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1822 CAL YOUNG RD APT 1411
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7661
Mailing Address - Country:US
Mailing Address - Phone:661-904-7968
Mailing Address - Fax:
Practice Address - Street 1:1822 CAL YOUNG RD APT 1411
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7661
Practice Address - Country:US
Practice Address - Phone:661-904-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health