Provider Demographics
NPI:1700895505
Name:LAWRENCE, SONDRA KAY (MS,LP)
Entity Type:Individual
Prefix:MS
First Name:SONDRA
Middle Name:KAY
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MS,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 2ND ST S STE 222
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1312
Mailing Address - Country:US
Mailing Address - Phone:132-020-2775
Mailing Address - Fax:320-259-7023
Practice Address - Street 1:110 2ND ST S STE 222
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1312
Practice Address - Country:US
Practice Address - Phone:320-202-7750
Practice Address - Fax:320-259-7023
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2528103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0897006OtherPREFERRED ONE
MN45D74LAOtherBCBS
MN45D74LAOtherBCBS