Provider Demographics
NPI:1174896872
Name:LAWRENCE SPEECH AND HEARING SERVICES
Entity type:Organization
Organization Name:LAWRENCE SPEECH AND HEARING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY/SPEECH PATHOLOG
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, CCC-A/SLP
Authorized Official - Phone:970-459-1179
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328-1256
Mailing Address - Country:US
Mailing Address - Phone:970-459-1179
Mailing Address - Fax:800-531-0273
Practice Address - Street 1:111 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCOS
Practice Address - State:CO
Practice Address - Zip Code:81321-8132
Practice Address - Country:US
Practice Address - Phone:970-459-1179
Practice Address - Fax:800-531-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-12
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD-644231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty