MEDICARE: MRS. TRINA LAWRENCE MSR, CCC-SLP

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	005137	GA

General Provider Information

NPI Number	:	1548485774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRINA LAWRENCE MSR, CCC-SLP

Provider Business Mailing Address
First Line	:	7658 FOREST GLEN WAY
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-6867
Country	:	US
Telephone Number	:	770-944-6155
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 AUBURN AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-1504
Country	:	US
Telephone Number	:	404-523-1613
Fax Number	:

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

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	07/08/2007

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