Provider Demographics
NPI:1578787321
Name:HAIGH GORE, LAUREL KATHLEEN (LMP)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:KATHLEEN
Last Name:HAIGH GORE
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 1:11323 14TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6313
Mailing Address - Country:US
Mailing Address - Phone:206-300-6227
Mailing Address - Fax:
Practice Address - Street 1:9100 ROOSEVELT WAY NE
Practice Address - Street 2:SUITE 103
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2852
Practice Address - Country:US
Practice Address - Phone:206-300-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014539174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist