Provider Demographics
NPI:1417156779
Name:DELAND, LAUREN HAYWARD (LMP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:HAYWARD
Last Name:DELAND
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 W 1ST AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-6011
Mailing Address - Country:US
Mailing Address - Phone:509-993-1048
Mailing Address - Fax:
Practice Address - Street 1:730 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2045
Practice Address - Country:US
Practice Address - Phone:509-993-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021657225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist