Healthcare Provider Details

I. General information

NPI: 1386781110
Provider Name (Legal Business Name): PAMELA LEE LAWRENCE MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1689 EAGLE HARBOR PKWY STE B
ORANGE PARK FL
32003-4802
US

IV. Provider business mailing address

2065 CREEKMONT DR
MIDDLEBURG FL
32068-6876
US

V. Phone/Fax

Practice location:
  • Phone: 904-637-0148
  • Fax:
Mailing address:
  • Phone: 904-272-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: