Provider Demographics
NPI:1679929822
Name:DUNCAN, LAVONNA J
Entity type:Individual
Prefix:MRS
First Name:LAVONNA
Middle Name:J
Last Name:DUNCAN
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 1:1350 CYPRESS RIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKE ALFRED
Mailing Address - State:FL
Mailing Address - Zip Code:33850-2001
Mailing Address - Country:US
Mailing Address - Phone:407-922-0585
Mailing Address - Fax:
Practice Address - Street 1:1350 CYPRESS RIDGE LOOP
Practice Address - Street 2:
Practice Address - City:LAKE ALFRED
Practice Address - State:FL
Practice Address - Zip Code:33850-2001
Practice Address - Country:US
Practice Address - Phone:407-922-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 14504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist