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General NPI Number Information
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NPI Number | 1144339896
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Entity Type | Individual
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Provider Name | LORI JANET VANDERBURG M.S.
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 19031 33RD AVE W SUITE 303
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City | LYNNWOOD
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State | WA
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Zip | 98036-4731
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Country | US
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Telephone | 425-640-7919
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Fax | 425-640-9087
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Provider Business Mailing Address
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Address Line | 1638 N 183RD ST
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City | SHORELINE
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State | WA
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Zip | 98133-4608
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Country | US
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Telephone | 206-909-1301
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Fax | 425-349-8815
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF00001559
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License Number State | WA
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