Healthcare Provider Details

I. General information

NPI: 1326327966
Provider Name (Legal Business Name): VICTORIA LESA LAWSHE M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2011
Last Update Date: 08/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 KELLER PKWY
KELLER TX
76248-3614
US

IV. Provider business mailing address

5608 PUERTO VALLARTA DR
N RICHLAND HILLS TX
76180-6560
US

V. Phone/Fax

Practice location:
  • Phone: 817-562-3111
  • Fax: 817-562-3114
Mailing address:
  • Phone: 817-300-8425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17763
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: