Provider Demographics
NPI:1417097825
Name:LAWLOR-KNIGHT, MEL (SLP)
Entity Type:Individual
Prefix:
First Name:MEL
Middle Name:
Last Name:LAWLOR-KNIGHT
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 1:5401 HOMESTEAD CIR NW
Mailing Address - Street 2:CHAMIZA ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2900
Mailing Address - Country:US
Mailing Address - Phone:505-897-5174
Mailing Address - Fax:
Practice Address - Street 1:5401 HOMESTEAD CIR NW
Practice Address - Street 2:CHAMIZA ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2900
Practice Address - Country:US
Practice Address - Phone:505-897-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ 5045Medicaid