Provider Demographics
NPI:1053398651
Name:LAWSON, WENDY S (PSYD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:S
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-2910
Mailing Address - Country:US
Mailing Address - Phone:570-325-3235
Mailing Address - Fax:
Practice Address - Street 1:264 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6224
Practice Address - Country:US
Practice Address - Phone:610-866-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2679863000OtherINDEPENDENCE BC
PALA1804248OtherHIGHMARK
PA50056293OtherCAPITAL BC
PA2679863000OtherINDEPENDENCE BC
PAQ65181Medicare UPIN