Provider Demographics
NPI:1346359163
Name:BROWN, LAURA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:S
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4131 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4910
Mailing Address - Country:US
Mailing Address - Phone:206-633-2405
Mailing Address - Fax:206-632-1793
Practice Address - Street 1:3429 FREMONT PL N STE 319
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8661
Practice Address - Country:US
Practice Address - Phone:206-633-2045
Practice Address - Fax:206-632-3179
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0615103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000109953Medicare ID - Type Unspecified