Provider Demographics
NPI:1548409568
Name:LAWLIS, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LAWLIS
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 1:3640 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3639
Mailing Address - Country:US
Mailing Address - Phone:307-259-6722
Mailing Address - Fax:
Practice Address - Street 1:3911 AVENUE B
Practice Address - Street 2:SUITE G200
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4617
Practice Address - Country:US
Practice Address - Phone:308-630-1355
Practice Address - Fax:308-630-2299
Is Sole Proprietor?:No
Enumeration Date:2009-02-14
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1419235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NESP-1419OtherNE SPEECH PATHOLOGY LICENSE
01111510OtherASHA