Individual
JO ANN LAVENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSP
Contact information
Practice address
3001 BEECHAVEN RD, COLUMBIA, SC 29204-2701
(803) 782-4363
Mailing address
811 FOREST PARK RD, COLUMBIA, SC 29209-2581
(843) 858-4456
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5859
SC
Other
Enumeration date
12/19/2015
Last updated
12/19/2015
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