Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 225700000X | Massage Therapist | MA00013047 | WA |
NPI | 1013295765 |
---|---|
Provider Name | Stacey Lawrence |
First Address | Lakewood, WA 98499-2858 |
Second Address | Lakewood, WA 98499-6600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2011 |
Last Update Date | 05/03/2013 |