Healthcare Provider Details

I. General information

NPI: 1093246597
Provider Name (Legal Business Name): REBEKAH GAIL LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W 8TH AVE
SPOKANE WA
99204-2506
US

IV. Provider business mailing address

1617 S KALANCHOE AVE
BROKEN ARROW OK
74012-9074
US

V. Phone/Fax

Practice location:
  • Phone: 918-404-8198
  • Fax:
Mailing address:
  • Phone: 918-760-7001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: