Provider Demographics
NPI:1447765938
Name:BENZ, LAUREL (LIACSW)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:BENZ
Suffix:
Gender:F
Credentials:LIACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 22ND ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-3442
Mailing Address - Country:US
Mailing Address - Phone:253-833-5908
Mailing Address - Fax:
Practice Address - Street 1:1345 22ND ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-3442
Practice Address - Country:US
Practice Address - Phone:253-833-5908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA606045841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical