Provider Demographics
NPI:1518784487
Name:LAWLESS-LANE, CHARLENE ANN
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ANN
Last Name:LAWLESS-LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TRAVERSE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3232
Mailing Address - Country:US
Mailing Address - Phone:978-758-4383
Mailing Address - Fax:
Practice Address - Street 1:6 TRAVERSE ST FL 2
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-3232
Practice Address - Country:US
Practice Address - Phone:978-758-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty