Provider Demographics
NPI:1568666774
Name:LAWSON, AMANDA RENEE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RENEE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32361 S WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-9680
Mailing Address - Country:US
Mailing Address - Phone:971-219-8980
Mailing Address - Fax:
Practice Address - Street 1:13110 SE SUNNYSIDE RD STE B
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8468
Practice Address - Country:US
Practice Address - Phone:503-698-5866
Practice Address - Fax:503-698-5787
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10138174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist