Healthcare Provider Details

I. General information

NPI: 1508785973
Provider Name (Legal Business Name): LAUREN JUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 N COOK ST
SPOKANE WA
99207-5879
US

IV. Provider business mailing address

4001 N COOK ST
SPOKANE WA
99207-5879
US

V. Phone/Fax

Practice location:
  • Phone: 509-326-4382
  • Fax:
Mailing address:
  • Phone: 509-326-4382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDERE.RR.70110187
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: