Provider Demographics
NPI:1093910473
Name:LAWRENCE, SHELLEY ANN (MS)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:ANN
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4495 WILLHI ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-1358
Mailing Address - Country:US
Mailing Address - Phone:541-913-4842
Mailing Address - Fax:
Practice Address - Street 1:780 HIGHWAY 99 N
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-2301
Practice Address - Country:US
Practice Address - Phone:541-465-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor