Doctor Name: | MRS. JILL NICOLE LAWRENCE |
NPI Number: | 1154596419 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC/SLP |
License Number: | 4920 |
Business Practice Address: | 1400 Ne Main St Bethany Alf Vidalia, GA - 30474 |
Business Phone Number: | 9123753797 |
Business Fax Number: | |
Mailing Address: | Po Box 53, ALAMO |
State: | GA |
Postal Code: | 304110053 |
Phone Number: | 9125235683 |
Fax Number: | |
NPI Enumeration Date: | 04/28/2008 |
NPI Last Update Date: | 04/28/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 4920 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |