Healthcare Provider Details

I. General information

NPI: 1104789940
Provider Name (Legal Business Name): VANESSA RAMOS LAIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 CALLAHAN DRIVE, STE C
BREMERTON WA
98310
US

IV. Provider business mailing address

3429 NW KENSINGTON LN APT 101
SILVERDALE WA
98383-7611
US

V. Phone/Fax

Practice location:
  • Phone: 360-240-0022
  • Fax:
Mailing address:
  • Phone: 360-240-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: