MEDICARE: DAWN LA CLAIR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4773	SC
2	235Z00000X	Speech-Language Pathologist	007485	NY

General Provider Information

NPI Number	:	1326359381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN LA CLAIR

Provider Business Mailing Address
First Line	:	242 EBENEZER AVE
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-4012
Country	:	US
Telephone Number	:	803-981-1435
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 EBENEZER AVE
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-4012
Country	:	US
Telephone Number	:	803-981-1435
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	08/15/2013

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Directions to “ DAWN LA CLAIR ” Practice Location

Language	Start Address	Practice Location

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