Provider Demographics
NPI:1538298831
Name:LAWRENCE ROSS, CAROLYN A (SLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:LAWRENCE ROSS
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 1:200 WELLMORE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9157
Mailing Address - Country:US
Mailing Address - Phone:803-500-1194
Mailing Address - Fax:803-674-0500
Practice Address - Street 1:200 WELLMORE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9157
Practice Address - Country:US
Practice Address - Phone:803-500-1194
Practice Address - Fax:803-674-0500
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006527235Z00000X
SC2081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC426614Medicare Oscar/Certification