Provider Demographics
NPI:1144836180
Name:PERRY, LAURA MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-0145
Mailing Address - Country:US
Mailing Address - Phone:863-265-0700
Mailing Address - Fax:
Practice Address - Street 1:2073 BAKER HWY
Practice Address - Street 2:
Practice Address - City:MOORE HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33471-6445
Practice Address - Country:US
Practice Address - Phone:863-265-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2370235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist