Healthcare Provider Details

I. General information

NPI: 1114839032
Provider Name (Legal Business Name): VANESSA BROOKE LAUZON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 W INA RD STE 109
TUCSON AZ
85704-1975
US

IV. Provider business mailing address

1625 W INA RD STE 109
TUCSON AZ
85704-1975
US

V. Phone/Fax

Practice location:
  • Phone: 520-363-6851
  • Fax:
Mailing address:
  • Phone: 520-363-6851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-449778
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: