Provider Demographics
NPI:1477362960
Name:VEISALOV, LACHIN
Entity type:Individual
Prefix:
First Name:LACHIN
Middle Name:
Last Name:VEISALOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6788 ANTHEM ST E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-3804
Mailing Address - Country:US
Mailing Address - Phone:206-397-6915
Mailing Address - Fax:
Practice Address - Street 1:6788 ANTHEM ST E
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-3804
Practice Address - Country:US
Practice Address - Phone:206-397-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty