Provider Demographics
NPI:1902964927
Name:JASPER, LAWRENCE GRANT (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GRANT
Last Name:JASPER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 JENNISON RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4211
Mailing Address - Country:US
Mailing Address - Phone:603-455-8590
Mailing Address - Fax:603-737-1004
Practice Address - Street 1:423 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3782
Practice Address - Country:US
Practice Address - Phone:603-524-0165
Practice Address - Fax:603-737-1004
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH171103G00000X, 103TC0700X, 103TC2200X, 103TH0100X, 103TM1800X, 103TP2701X, 103TR0400X
103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation