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General NPI Number Information
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NPI Number | 1619315330
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Entity Type | Individual
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Provider Name | CHRISTINA BOOVER LAWRENCE AU.D., CCC-A/SLP
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Gender | Female
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 111 N MAIN ST
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City | MANCOS
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State | CO
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Zip | 81328-5004
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Country | US
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Telephone | 970-459-1179
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1256
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City | MANCOS
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State | CO
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Zip | 81328-1256
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Country | US
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Telephone | 197-045-9117
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Fax | 800-531-0273
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 644
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License Number State | CO
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