Provider Demographics
NPI:1265490882
Name:LAWSON, SHELLY GRAHAM (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:GRAHAM
Last Name:LAWSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 MIDLAND PARKWAY
Mailing Address - Street 2:APT 104
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485
Mailing Address - Country:US
Mailing Address - Phone:843-209-4907
Mailing Address - Fax:
Practice Address - Street 1:301 OAKBROOK LANE
Practice Address - Street 2:SUITE 335
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485
Practice Address - Country:US
Practice Address - Phone:843-832-1795
Practice Address - Fax:843-832-9499
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist