Provider Demographics
NPI:1063108603
Name:LAWRENCE, KATHLEEN (ND)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 SW 11TH AVE STE 525
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2131
Mailing Address - Country:US
Mailing Address - Phone:503-294-7070
Mailing Address - Fax:971-200-8962
Practice Address - Street 1:833 SW 11TH AVE STE 525
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2131
Practice Address - Country:US
Practice Address - Phone:503-294-7070
Practice Address - Fax:971-200-8962
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5004175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath