Provider Demographics
NPI:1295932002
Name:LAASI, MICHELLE NORA (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:NORA
Last Name:LAASI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S WINCHESTER BLVD
Mailing Address - Street 2:STE H186
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-446-4411
Mailing Address - Fax:408-446-4422
Practice Address - Street 1:1101 S WINCHESTER BLVD
Practice Address - Street 2:STE H186
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-446-4411
Practice Address - Fax:408-446-4422
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 12075103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist