Provider Demographics
NPI:1235317132
Name:LAWSON, MIA KAY (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:KAY
Last Name:LAWSON
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 VINTAGE CIR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-1647
Mailing Address - Country:US
Mailing Address - Phone:850-622-5192
Mailing Address - Fax:850-416-7348
Practice Address - Street 1:732 VINTAGE CIR
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-1647
Practice Address - Country:US
Practice Address - Phone:850-622-5192
Practice Address - Fax:850-416-7348
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist