Healthcare Provider Details

I. General information

NPI: 1851818843
Provider Name (Legal Business Name): ANDREA MARIE LAZZARI SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 THREE CHOPT RD
HENRICO VA
23233-1134
US

IV. Provider business mailing address

2165 KELLY RIDGE RD
HENRICO VA
23233-6908
US

V. Phone/Fax

Practice location:
  • Phone: 804-364-0830
  • Fax:
Mailing address:
  • Phone: 804-360-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202000426
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: