Provider Demographics
NPI:1538562392
Name:NOVOTNY, LAURA ANNRQ (MS ED)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNRQ
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 TILBY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1255
Mailing Address - Country:US
Mailing Address - Phone:440-465-4809
Mailing Address - Fax:
Practice Address - Street 1:3800 W 140TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4972
Practice Address - Country:US
Practice Address - Phone:216-920-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-5422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist