Provider Demographics
NPI:1487725511
Name:SOLOMON, LAURIE JO (LAC, MSAOM)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:JO
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:LAC, MSAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1342
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-1342
Mailing Address - Country:US
Mailing Address - Phone:503-939-0521
Mailing Address - Fax:360-263-4896
Practice Address - Street 1:304 S PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9295
Practice Address - Country:US
Practice Address - Phone:360-666-1070
Practice Address - Fax:360-263-4896
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000684171100000X
ORAC00551171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist