Provider Demographics
NPI:1831217330
Name:GLOVER - LAWRENCE, FELICIA P (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:P
Last Name:GLOVER - LAWRENCE
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 1:1408 RUSSELL ST STE 14
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-6071
Mailing Address - Country:US
Mailing Address - Phone:803-534-1200
Mailing Address - Fax:
Practice Address - Street 1:1408 RUSSELL ST STE 14
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6071
Practice Address - Country:US
Practice Address - Phone:803-378-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3989235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist