Provider Demographics
NPI:1467908368
Name:LAKE NORMAN COMMUNICATION SERVICES, INC.
Entity Type:Organization
Organization Name:LAKE NORMAN COMMUNICATION SERVICES, INC.
Other - Org Name:PAM MANSER & ASSOCIATES SPEECH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:MANSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-293-6552
Mailing Address - Street 1:484 WILLIAMSON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8191
Mailing Address - Country:US
Mailing Address - Phone:704-793-8475
Mailing Address - Fax:
Practice Address - Street 1:484 WILLIAMSON RD STE 102
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8191
Practice Address - Country:US
Practice Address - Phone:704-293-6552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
NC4057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13882320OtherCAQH
13882320OtherCAQH