Provider Demographics
NPI:1124280276
Name:DEDMON, LAURIE CATHERINE (CMT, MA)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:CATHERINE
Last Name:DEDMON
Suffix:
Gender:F
Credentials:CMT, MA
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:CATHERINE
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2936 ROBINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-3402
Mailing Address - Country:US
Mailing Address - Phone:559-392-5517
Mailing Address - Fax:
Practice Address - Street 1:2936 ROBINWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-3402
Practice Address - Country:US
Practice Address - Phone:559-392-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA953907 ABMP175F00000X
CACLOVIS PERMIT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No175F00000XOther Service ProvidersNaturopath