Provider Demographics
NPI:1104467778
Name:THOMPSON, LARA A (ND)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:A
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15515 JUANITA WDVL WAY NE UNIT D103
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-1584
Mailing Address - Country:US
Mailing Address - Phone:206-485-0854
Mailing Address - Fax:877-842-5128
Practice Address - Street 1:16825 48TH AVE W STE 301
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-6407
Practice Address - Country:US
Practice Address - Phone:206-485-0854
Practice Address - Fax:877-842-5128
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT61007396175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath