Provider Demographics
NPI:1073404364
Name:KURDALI-RICKS, LAELA
Entity type:Individual
Prefix:
First Name:LAELA
Middle Name:
Last Name:KURDALI-RICKS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 WESTMINISTER DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3440
Mailing Address - Country:US
Mailing Address - Phone:601-506-5173
Mailing Address - Fax:
Practice Address - Street 1:1305 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7640
Practice Address - Country:US
Practice Address - Phone:601-544-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist