Individual
MISS LANETRA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
379 PINEHAVEN STREET EXT, LAURENS, SC 29360-2672
(864) 984-6584
Mailing address
379 PINEHAVEN STREET EXT, LAURENS, SC 29360-2672
(864) 984-6584
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5368
SC
Other
Enumeration date
06/27/2013
Last updated
10/09/2013
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