Provider Demographics
NPI:1235532649
Name:LAVIOLETTE, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LAVIOLETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 VILLAGE FOREST PL
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8106
Mailing Address - Country:US
Mailing Address - Phone:407-677-7274
Mailing Address - Fax:
Practice Address - Street 1:1197 VILLAGE FOREST PL
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8106
Practice Address - Country:US
Practice Address - Phone:407-677-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist