Provider Demographics
NPI:1396167441
Name:HIRSH, LAURA (PSYD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HIRSH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6869 WOODLAWN AVE NE STE 206
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5469
Mailing Address - Country:US
Mailing Address - Phone:206-492-3279
Mailing Address - Fax:206-984-0008
Practice Address - Street 1:6869 WOODLAWN AVE NE STE 206
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5469
Practice Address - Country:US
Practice Address - Phone:206-492-3279
Practice Address - Fax:206-984-0008
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
WA60416260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist