Provider Demographics
NPI:1922555366
Name:SHERIDAN, LAURA JEANNE (MAED)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEANNE
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16825 48TH AVE W
Mailing Address - Street 2:STE. # 127
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-6401
Mailing Address - Country:US
Mailing Address - Phone:425-405-0560
Mailing Address - Fax:
Practice Address - Street 1:16825 48TH AVE W
Practice Address - Street 2:STE. # 127
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-6401
Practice Address - Country:US
Practice Address - Phone:425-405-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health