Provider Demographics
NPI:1831297233
Name:DAHMER-WHITE, LAURA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:DAHMER-WHITE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:KAY
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 RW JOHNSON RD. SW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6133
Mailing Address - Country:US
Mailing Address - Phone:360-709-0601
Mailing Address - Fax:360-528-2080
Practice Address - Street 1:2620 RW JOHNSON RD. SW
Practice Address - Street 2:SUITE 204
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98516-6133
Practice Address - Country:US
Practice Address - Phone:360-709-0601
Practice Address - Fax:360-528-2080
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1872103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R57490Medicare ID - Type Unspecified