Provider Demographics
NPI:1326577537
Name:BURNETT, LAURA GRACE (BA, CAAR)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:GRACE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:BA, CAAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-2665
Mailing Address - Country:US
Mailing Address - Phone:360-490-2723
Mailing Address - Fax:360-427-0357
Practice Address - Street 1:110 W K ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2944
Practice Address - Country:US
Practice Address - Phone:360-426-1696
Practice Address - Fax:360-427-0357
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator