Individual
LAURA LEACIE WILSON WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2550 E FOOTHILL BLVD, PASADENA, CA 91107-3406
(626) 744-5230
Mailing address
2550 E FOOTHILL BLVD, PASADENA, CA 91107-3406
(626) 744-5230
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
31585
CA
225C00000X
Rehabilitation Counselor
—
—
Other
Enumeration date
06/29/2014
Last updated
09/15/2022
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