Provider Demographics
NPI:1841347630
Name:LAWRENCE, LEE A
Entity type:Individual
Prefix:MRS
First Name:LEE
Middle Name:A
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:MARK
Other - Middle Name:J
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:245 TOM MILLER RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6428
Mailing Address - Country:US
Mailing Address - Phone:518-563-1748
Mailing Address - Fax:
Practice Address - Street 1:245 TOM MILLER RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6428
Practice Address - Country:US
Practice Address - Phone:518-563-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000009130237600000X
NY14000009129237600000X
NY15000005931237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist