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Individual

MS. LAURA MARIE ULLOA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW, LCSW

Contact information

Practice address
931 CHEVY WAY, MEDFORD, OR 97504-4127
(541) 535-6239
Mailing address
931 CHEVY WAY, MEDFORD, OR 97504-4127
(541) 535-6239

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
L8473
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500718925
OR
Enumeration date
09/17/2013
Last updated
03/07/2024
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