Healthcare Provider Details

I. General information

NPI: 1831743590
Provider Name (Legal Business Name): LAUREN GRACE MINOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN GRACE HOFFMAN

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19204 N CREEK PKWY STE 110
BOTHELL WA
98011-8009
US

IV. Provider business mailing address

14704 22ND AVE NE
SHORELINE WA
98155-7303
US

V. Phone/Fax

Practice location:
  • Phone: 888-805-0759
  • Fax:
Mailing address:
  • Phone: 818-241-6853
  • Fax: 818-241-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA.BA.70017330
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: