Provider Demographics
NPI:1124202684
Name:TEPPER, LAUREL C (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:C
Last Name:TEPPER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 VETERANS DR SW
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-0003
Mailing Address - Country:US
Mailing Address - Phone:253-583-1169
Mailing Address - Fax:253-589-4166
Practice Address - Street 1:9600 VETERANS DR SW
Practice Address - Street 2:BUILDING 4
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0003
Practice Address - Country:US
Practice Address - Phone:253-583-1169
Practice Address - Fax:253-589-4166
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601177731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical