Provider Demographics
NPI:1356835938
Name:KANEAKUA, LAURA MAY SPAHN X (MHT LLL)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MAY SPAHN
Last Name:KANEAKUA
Suffix:X
Gender:F
Credentials:MHT LLL
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:KANEAKUA
Other - Suffix:X
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4526 FEDERAL AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2132
Mailing Address - Country:US
Mailing Address - Phone:425-349-6200
Mailing Address - Fax:
Practice Address - Street 1:4526 FEDERAL AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2132
Practice Address - Country:US
Practice Address - Phone:425-349-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty