Provider Demographics
NPI:1619200771
Name:MCLAUGHLIN, JUANITA ANN (LAC)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:ANN
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:CO
Mailing Address - Zip Code:80466-0004
Mailing Address - Country:US
Mailing Address - Phone:303-258-9112
Mailing Address - Fax:
Practice Address - Street 1:1629 CANYON BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5406
Practice Address - Country:US
Practice Address - Phone:303-258-9112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1048171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist