Healthcare Provider Details

I. General information

NPI: 1306844584
Provider Name (Legal Business Name): JOAN ALFREDA LAWRENCE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 W HIGH ST
BRYAN OH
43506-1681
US

IV. Provider business mailing address

PO BOX 53
BRYAN OH
43506-0053
US

V. Phone/Fax

Practice location:
  • Phone: 567-225-7954
  • Fax: 419-553-3360
Mailing address:
  • Phone: 567-225-7954
  • Fax: 419-553-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4724
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301008622
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: