MEDICARE: DENISE ROBINSON LAWRENCE MA, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	6740	NC
2	235Z00000X	Speech-Language Pathologist	SLP006820	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	141EM	OTHER	NC	NC BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306822788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE ROBINSON LAWRENCE MA, CCC-SLP

Provider Business Mailing Address
First Line	:	7634 BRAZOS TRAIL
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213
Country	:	US
Telephone Number	:	704-264-9422
Fax Number	:	678-489-6116

Provider Business Practice Location Address
First Line	:	7634 BRAZOS TRAIL
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213
Country	:	US
Telephone Number	:	704-264-9422
Fax Number	:	678-489-6116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	04/22/2013

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