Provider Demographics
NPI:1861963423
Name:KOCAN, LAURA ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:KOCAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7722 RAY ST
Mailing Address - Street 2:
Mailing Address - City:FORT GEORGE G MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-1041
Mailing Address - Country:US
Mailing Address - Phone:410-222-6545
Mailing Address - Fax:
Practice Address - Street 1:7722 RAY ST
Practice Address - Street 2:
Practice Address - City:FORT GEORGE G MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-1041
Practice Address - Country:US
Practice Address - Phone:410-222-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07594235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist