Healthcare Provider Details

I. General information

NPI: 1639386121
Provider Name (Legal Business Name): SHAWNA LANE LAWSON SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 13TH ST
HUNTINGTON WV
25701-1653
US

IV. Provider business mailing address

RR 2 BOX 5
WEST HAMLIN WV
25571-9701
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-7622
  • Fax:
Mailing address:
  • Phone: 304-824-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0904
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: