Provider Demographics
NPI:1558169235
Name:TAGG, LAURA BLAKE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BLAKE
Last Name:TAGG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3522
Mailing Address - Country:US
Mailing Address - Phone:541-608-6868
Mailing Address - Fax:
Practice Address - Street 1:500 MONROE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3522
Practice Address - Country:US
Practice Address - Phone:541-608-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker