Provider Demographics
NPI:1083619506
Name:LAWSON, WARD M
Entity Type:Individual
Prefix:
First Name:WARD
Middle Name:M
Last Name:LAWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 W HUBBLE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-1532
Mailing Address - Country:US
Mailing Address - Phone:417-859-4878
Mailing Address - Fax:417-859-0889
Practice Address - Street 1:543 W HUBBLE DR
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-1532
Practice Address - Country:US
Practice Address - Phone:417-859-4878
Practice Address - Fax:417-859-0889
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01525103TC1900X, 103TC1900X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493580138Medicaid
MO493580138Medicaid
MO712504514Medicare ID - Type Unspecified