Healthcare Provider Details

I. General information

NPI: 1962142976
Provider Name (Legal Business Name): MADELINE LAOPRASERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24120 VAN RY BLVD STE 400
MOUNTLAKE TERRACE WA
98043-5459
US

IV. Provider business mailing address

24120 VAN RY BLVD STE 400
MOUNTLAKE TERRACE WA
98043-5459
US

V. Phone/Fax

Practice location:
  • Phone: 425-245-9940
  • Fax:
Mailing address:
  • Phone: 425-245-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB1233457
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: