Healthcare Provider Details

I. General information

NPI: 1356206635
Provider Name (Legal Business Name): LAVAUN COTTRELL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4806 WEBSTER RD
YAKIMA WA
98908-2449
US

IV. Provider business mailing address

4806 WEBSTER RD
YAKIMA WA
98908-2449
US

V. Phone/Fax

Practice location:
  • Phone: 509-972-3358
  • Fax:
Mailing address:
  • Phone: 509-972-3358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDEHY.DH.00006946
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: