Provider Demographics
NPI:1801949466
Name:LAWSON, BENJAMIN MAKEHAM (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:MAKEHAM
Last Name:LAWSON
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3369 RAMBLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3842
Mailing Address - Country:US
Mailing Address - Phone:941-363-0139
Mailing Address - Fax:
Practice Address - Street 1:3817 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9041
Practice Address - Country:US
Practice Address - Phone:941-745-5111
Practice Address - Fax:941-745-5667
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist