Most Relevant Information
Provider Data
| NPI Number: | 1003007444 |
| Provider Name: | BLANCA V. LAURSEN SUDP |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | RC00039617 |
Most Important Dates
| Enumeration Date: | 08/08/2007 |
| Last Updated: | 11/03/2022 |
Provider Practice Location
1601 E COLLEGE WAY
MOUNT VERNON
WA
982735612
Practice Location Phone/Fax
| Phone: | 3607635595 |
| Fax: | 3603997639 |
Provider Mailing Location
1601 E COLLEGE WAY
MOUNT VERNON
WA
982735612
Provider Mailing Phone/Fax
| Phone: | 3607635595 |
| Fax: | 3603997639 |