Provider Demographics
NPI:1144339896
Name:VANDERBURG, LORI JANET (MS)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:JANET
Last Name:VANDERBURG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 N 183RD ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4608
Mailing Address - Country:US
Mailing Address - Phone:206-909-1301
Mailing Address - Fax:425-349-8815
Practice Address - Street 1:19031 33RD AVE W
Practice Address - Street 2:SUITE 303
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4731
Practice Address - Country:US
Practice Address - Phone:425-640-7919
Practice Address - Fax:425-640-9087
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist