Provider Demographics
NPI:1306162623
Name:HARGROVE, LACARRA GODFREY (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LACARRA
Middle Name:GODFREY
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:314 STEPHENSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4347
Mailing Address - Country:US
Mailing Address - Phone:912-355-3392
Mailing Address - Fax:912-355-3372
Practice Address - Street 1:314 STEPHENSON AVE STE A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4347
Practice Address - Country:US
Practice Address - Phone:912-355-3392
Practice Address - Fax:912-355-3372
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist