Provider Demographics
NPI:1578703856
Name:MALIK-LAWSON, JENNIFER NICOLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:MALIK-LAWSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W UNIVERSITY DR
Mailing Address - Street 2:STE 111
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-1801
Mailing Address - Country:US
Mailing Address - Phone:940-387-2939
Mailing Address - Fax:940-387-0434
Practice Address - Street 1:231 W UNIVERSITY DR
Practice Address - Street 2:STE 111
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-1801
Practice Address - Country:US
Practice Address - Phone:940-387-2939
Practice Address - Fax:940-387-0434
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00456000235Z00000X
TX108906235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist