Provider Demographics
NPI:1982026142
Name:LAWSON, MARINA (LAC)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:LAWSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8566 S KINGS COVE DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6006
Mailing Address - Country:US
Mailing Address - Phone:541-490-1979
Mailing Address - Fax:
Practice Address - Street 1:7105 S HIGHLAND DR
Practice Address - Street 2:SUITE 202
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3753
Practice Address - Country:US
Practice Address - Phone:541-490-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8836290-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist