Provider Demographics
NPI:1548764731
Name:CLARKSON, LAUREN ELIZABETH ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH ANNE
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH ANNE
Other - Last Name:TAURIAINEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 1091
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-1091
Mailing Address - Country:US
Mailing Address - Phone:907-690-2892
Mailing Address - Fax:
Practice Address - Street 1:35249 KENAI SPUR HWY
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7623
Practice Address - Country:US
Practice Address - Phone:907-690-2892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK127583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist