Healthcare Provider Details

I. General information

NPI: 1083531446
Provider Name (Legal Business Name): LAURA HARRISON MARQUEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 15TH AVE S STE 102
SEATTLE WA
98108-1874
US

IV. Provider business mailing address

9026 13TH AVE SW
SEATTLE WA
98106-2441
US

V. Phone/Fax

Practice location:
  • Phone: 206-963-0496
  • Fax:
Mailing address:
  • Phone: 206-963-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.70011029
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: