Provider Demographics
NPI:1821533035
Name:WAGENDORF, LAUREN SHALANE (LMHC, LPCC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SHALANE
Last Name:WAGENDORF
Suffix:
Gender:F
Credentials:LMHC, LPCC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:SHALANE
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:1375 121ST AVE NE APT 208
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-5069
Mailing Address - Country:US
Mailing Address - Phone:701-351-9100
Mailing Address - Fax:
Practice Address - Street 1:16150 NE 85TH ST STE 121
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3542
Practice Address - Country:US
Practice Address - Phone:425-868-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01367101YP2500X
WALH61000117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional