Provider Demographics
NPI:1427419852
Name:LAWRENCE, MIA ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:ELIZABETH
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:ELIZABETH
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:22 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1007
Practice Address - Country:US
Practice Address - Phone:607-437-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-12
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028344235Z00000X
MA9678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist