Provider Demographics
NPI:1164678249
Name:WINSLOW, LAURA J
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:WINSLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GENESSEE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7103
Mailing Address - Country:US
Mailing Address - Phone:541-779-5866
Mailing Address - Fax:541-779-1349
Practice Address - Street 1:111 GENESSEE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7103
Practice Address - Country:US
Practice Address - Phone:541-779-5866
Practice Address - Fax:541-779-1349
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)