Provider Demographics
NPI:1174928121
Name:MATSON, LAWRENCE (EDD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:MATSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7712
Mailing Address - Country:US
Mailing Address - Phone:970-371-5523
Mailing Address - Fax:
Practice Address - Street 1:2223 27TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-7712
Practice Address - Country:US
Practice Address - Phone:970-371-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-01
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No171WH0202XOther Service ProvidersContractorHome Modifications
No172V00000XOther Service ProvidersCommunity Health Worker