MEDICARE: MRS. VERONICA R CONNOLLY-BAGSHAW LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH00010931	WA

General Provider Information

NPI Number	:	1467690768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERONICA R CONNOLLY-BAGSHAW LMHC

Provider Business Mailing Address
First Line	:	20112 SE 20TH PL
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98075-7477
Country	:	US
Telephone Number	:	425-681-7996
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 LAKE BELLEVUE DR STE 220
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-2480
Country	:	US
Telephone Number	:	425-681-7996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2009
Last Update Date	:	01/26/2009

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