Provider Demographics
NPI:1730229915
Name:LAWRENCE, LEANNA BETH
Entity type:Individual
Prefix:MRS
First Name:LEANNA
Middle Name:BETH
Last Name:LAWRENCE
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 1:300 PORTLAND ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6569
Mailing Address - Country:US
Mailing Address - Phone:573-882-5496
Mailing Address - Fax:
Practice Address - Street 1:300 PORTLAND ST
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6569
Practice Address - Country:US
Practice Address - Phone:573-882-5496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000158738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist