Provider Demographics
NPI:1811247224
Name:LAWRENCE, FRED A (AAS, HIS)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:A
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:AAS, HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 E 2ND ST STE 107
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2578
Mailing Address - Country:US
Mailing Address - Phone:307-267-9000
Mailing Address - Fax:307-215-7474
Practice Address - Street 1:232 E 2ND ST STE 101
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2578
Practice Address - Country:US
Practice Address - Phone:307-267-9000
Practice Address - Fax:307-215-7474
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY169237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist