Provider Demographics
NPI:1306822788
Name:LAWRENCE, DENISE ROBINSON (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ROBINSON
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7634 BRAZOS TRAIL
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213
Mailing Address - Country:US
Mailing Address - Phone:704-264-9422
Mailing Address - Fax:678-489-6116
Practice Address - Street 1:7634 BRAZOS TRAIL
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213
Practice Address - Country:US
Practice Address - Phone:704-264-9422
Practice Address - Fax:678-489-6116
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6740235Z00000X
GASLP006820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA444072475AMedicaid
NC141EMOtherNC BCBS
NC7412440Medicaid