Provider Demographics
NPI:1821337361
Name:VAUGHAN, LAURA J (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:J
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21907 64TH AVE W
Mailing Address - Street 2:SUIITE 200
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2200
Mailing Address - Country:US
Mailing Address - Phone:206-319-4446
Mailing Address - Fax:
Practice Address - Street 1:21907 64TH AVE W
Practice Address - Street 2:SUIITE 200
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2200
Practice Address - Country:US
Practice Address - Phone:206-319-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60326918101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor