Provider Demographics
NPI:1700150752
Name:LAWRENCE, LISA JANE (MSCCC/SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JANE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4127 PONZA PL
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3436
Mailing Address - Country:US
Mailing Address - Phone:561-374-2543
Mailing Address - Fax:
Practice Address - Street 1:4127 PONZA PL
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-3436
Practice Address - Country:US
Practice Address - Phone:561-374-2543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist