Provider Demographics
NPI:1932288362
Name:LAWLER, KELLIE DIANE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:DIANE
Last Name:LAWLER
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2070
Mailing Address - Country:US
Mailing Address - Phone:360-217-7053
Mailing Address - Fax:360-217-7629
Practice Address - Street 1:1212 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2070
Practice Address - Country:US
Practice Address - Phone:360-217-7053
Practice Address - Fax:360-568-5106
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC2631171100000X
WANT1381175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6323LAOtherREGENCE ACUPUNCTURE
WA7632LAOtherNATUROPATHIC REGENCE