Provider Demographics
NPI:1902459241
Name:BARTENSTEIN, LAURA GRAY (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:GRAY
Last Name:BARTENSTEIN
Suffix:
Gender:F
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 1:12980 QUEEN CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4561
Mailing Address - Country:US
Mailing Address - Phone:703-590-0344
Mailing Address - Fax:
Practice Address - Street 1:12980 QUEEN CHAPEL RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-4561
Practice Address - Country:US
Practice Address - Phone:703-590-0344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist