Provider Demographics
NPI:1902334543
Name:LAWLER, JACQUELINE ROSE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ROSE
Last Name:LAWLER
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W CABARRUS ST APT 525
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-9820
Mailing Address - Country:US
Mailing Address - Phone:815-715-8934
Mailing Address - Fax:
Practice Address - Street 1:211 E SIX FORKS RD STE 219
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7755
Practice Address - Country:US
Practice Address - Phone:815-715-8934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003438235Z00000X
CO0002145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist