Provider Demographics
NPI:1801944194
Name:IKEHARA-MARTIN, LAURA (MSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:IKEHARA-MARTIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 NE 41ST ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6791
Mailing Address - Country:US
Mailing Address - Phone:360-253-6425
Mailing Address - Fax:360-253-3196
Practice Address - Street 1:7600 NE 41ST ST
Practice Address - Street 2:SUITE 310
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6791
Practice Address - Country:US
Practice Address - Phone:360-253-6425
Practice Address - Fax:360-253-3196
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000052451041C0700X
ORL11481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical