Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | LW61077072 | WA |
NPI | 1003265257 |
---|---|
Provider Name | Lauren Mallory |
First Address | Centralia, WA 98531-8929 |
Second Address | Lacey, WA 98503-1072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2016 |
Last Update Date | 10/11/2020 |