Provider Demographics
NPI:1467690768
Name:CONNOLLY-BAGSHAW, VERONICA R (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:R
Last Name:CONNOLLY-BAGSHAW
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20112 SE 20TH PL
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7477
Mailing Address - Country:US
Mailing Address - Phone:425-681-7996
Mailing Address - Fax:
Practice Address - Street 1:40 LAKE BELLEVUE DR STE 220
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2480
Practice Address - Country:US
Practice Address - Phone:425-681-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health