Provider Demographics
NPI:1538707534
Name:HORNUNG, LAURA ELISABETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELISABETH
Last Name:HORNUNG
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 1:1440 DICKINSON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4842
Mailing Address - Country:US
Mailing Address - Phone:610-883-7877
Mailing Address - Fax:
Practice Address - Street 1:1440 DICKINSON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-4842
Practice Address - Country:US
Practice Address - Phone:610-883-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10181991OtherBIRTHDAY