Basic Information
| Provider Information | |||||||||
| NPI: | 1457664294 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARTWRIGHT | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 413 N 20TH ST | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838145406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089301275 | ||||||||
| FaxNumber: | 2086252070 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 S 11TH ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838144000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089301275 | ||||||||
| FaxNumber: | 2089300330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2010 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW 30822 | ID | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LMSW-26735 | ID | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 30822 | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 2071711 | 05 | WA | MEDICAID |