Provider Demographics
NPI:1386956993
Name:SHOCKLEY, LAUREN RENE (LMP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:RENE
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1908
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98252-1908
Mailing Address - Country:US
Mailing Address - Phone:425-359-3433
Mailing Address - Fax:
Practice Address - Street 1:8411 STATE ROUTE 92
Practice Address - Street 2:SUITE #8
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252-8771
Practice Address - Country:US
Practice Address - Phone:425-359-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60063643225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist