Provider Demographics
NPI:1912385568
Name:LAWSON, ELIZABETH A (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:LAWSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 SPRING CREEK RD STE 16
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1157
Mailing Address - Country:US
Mailing Address - Phone:815-978-7705
Mailing Address - Fax:
Practice Address - Street 1:4320 SPRING CREEK RD STE 16
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1157
Practice Address - Country:US
Practice Address - Phone:815-978-7705
Practice Address - Fax:815-904-6419
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.014329104100000X
IL1490187801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF300349819Medicare PIN