Provider Demographics
NPI:1770600264
Name:GRAMLY -KELLEY, LAURA L (LAC, MTCM, MSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:GRAMLY -KELLEY
Suffix:
Gender:F
Credentials:LAC, MTCM, MSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:L
Other - Last Name:GRAMLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, MTCM, MSW
Mailing Address - Street 1:11008 21ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2045
Mailing Address - Country:US
Mailing Address - Phone:206-932-6114
Mailing Address - Fax:206-923-0577
Practice Address - Street 1:6053 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1612
Practice Address - Country:US
Practice Address - Phone:206-932-6114
Practice Address - Fax:206-923-0577
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002183171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist