Provider Demographics
NPI:1700966561
Name:TAKACS, LAURA (MSW, MPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:TAKACS
Suffix:
Gender:F
Credentials:MSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 OLIVE WAY
Mailing Address - Street 2:SUITE 531
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-223-6762
Mailing Address - Fax:
Practice Address - Street 1:1100 OLIVE WAY
Practice Address - Street 2:SUITE 531
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1873
Practice Address - Country:US
Practice Address - Phone:206-223-6762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000093911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical