Healthcare Provider Details

I. General information

NPI: 1578142238
Provider Name (Legal Business Name): LAUREN NICOLE CHESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HAYES ST FL 6
SAN FRANCISCO CA
94117-1013
US

IV. Provider business mailing address

2200 HAYES ST FL 6
SAN FRANCISCO CA
94117-1013
US

V. Phone/Fax

Practice location:
  • Phone: 706-973-9535
  • Fax:
Mailing address:
  • Phone: 706-973-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001665
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberART-C-10236427
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: