Provider Demographics
NPI:1457743627
Name:LINCLAU, LAUREN N (MED BCBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:N
Last Name:LINCLAU
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13010 NE 20TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2034
Mailing Address - Country:US
Mailing Address - Phone:425-644-6295
Mailing Address - Fax:
Practice Address - Street 1:13010 NE 20TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2034
Practice Address - Country:US
Practice Address - Phone:425-644-6295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-16843103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst