MEDICARE: DR. ANNIE NICHOLE LAWERYSON PH.D., MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY61123471	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548798200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNIE NICHOLE LAWERYSON PH.D., MS

Provider Business Mailing Address
First Line	:	5224 OLYMPIC DR STE 108
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1792
Country	:	US
Telephone Number	:	253-528-3242
Fax Number	:	253-357-0835

Provider Business Practice Location Address
First Line	:	5224 OLYMPIC DR STE 108
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1792
Country	:	US
Telephone Number	:	253-528-3242
Fax Number	:	253-357-0835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2017
Last Update Date	:	04/19/2026

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