Healthcare Provider Details

I. General information

NPI: 1164519898
Provider Name (Legal Business Name): SUZANNE MOXHAM LAWRENCE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 HIGHLAND AVE
KNOXVILLE TN
37916-1112
US

IV. Provider business mailing address

9721 FRANKLIN HILL BLVD
KNOXVILLE TN
37922-3332
US

V. Phone/Fax

Practice location:
  • Phone: 865-523-2473
  • Fax: 865-523-9773
Mailing address:
  • Phone: 865-693-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0427
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: