Provider Demographics
NPI:1326359381
Name:LA CLAIR, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:LA CLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 EBENEZER AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4012
Mailing Address - Country:US
Mailing Address - Phone:803-981-1435
Mailing Address - Fax:
Practice Address - Street 1:242 EBENEZER AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4012
Practice Address - Country:US
Practice Address - Phone:803-981-1435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4773235Z00000X
NY007485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist