Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY 680 | HI |
N | 103TC0700X | Clinical Psychologist | PSY 680 | HI |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY 680 | HI |
NPI | 1134460926 |
---|---|
Provider Name | Dr. Laura Sprague Anderson |
First Address | Kilauea, HI 96754-1237 |
Second Address | Kapaa, HI 96746-1745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2013 |
Last Update Date | 05/03/2013 |