Provider Demographics
NPI:1295945103
Name:LAWRENCE, SUSAN M (LAC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:LAWRENCE
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 1:5400 SW ERICKSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3847
Mailing Address - Country:US
Mailing Address - Phone:503-936-6104
Mailing Address - Fax:
Practice Address - Street 1:5400 SW ERICKSON AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3847
Practice Address - Country:US
Practice Address - Phone:503-936-6104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00720171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist