MEDICARE: MS. SONDRA KAY LAWRENCE M.S.,L.P.

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	103T00000X	Psychologist	LP 2528	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0897006	OTHER	MN	PREFERRED ONE
2	45D74LA	OTHER	MN	BCBS

General Provider Information

NPI Number	:	1700895505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SONDRA KAY LAWRENCE M.S.,L.P.

Provider Business Mailing Address
First Line	:	110 2ND ST S STE 222
Second Line	:
City	:	WAITE PARK
State	:	MN
Zip	:	56387-1312
Country	:	US
Telephone Number	:	132-020-2775
Fax Number	:	320-259-7023

Provider Business Practice Location Address
First Line	:	110 2ND ST S STE 222
Second Line	:
City	:	WAITE PARK
State	:	MN
Zip	:	56387-1312
Country	:	US
Telephone Number	:	320-202-7750
Fax Number	:	320-259-7023

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	11/06/2018

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