Provider Demographics
NPI:1538305263
Name:BLACKEN, LAUREN (CO)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BLACKEN
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CO
Mailing Address - Street 1:2500 CHERRY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4202
Mailing Address - Country:US
Mailing Address - Phone:360-478-2087
Mailing Address - Fax:360-405-6303
Practice Address - Street 1:2500 CHERRY AVE STE 102
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4202
Practice Address - Country:US
Practice Address - Phone:360-478-2087
Practice Address - Fax:360-405-6303
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAO100000462222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist