Provider Demographics
NPI:1629002944
Name:LAWRENCE, SHAANTI ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHAANTI
Middle Name:ANNE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 LEOPOLD LN
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8470
Mailing Address - Country:US
Mailing Address - Phone:509-302-7959
Mailing Address - Fax:
Practice Address - Street 1:303 BRADLEY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4497
Practice Address - Country:US
Practice Address - Phone:509-302-7959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical