Provider Demographics
NPI:1003112780
Name:MCGUIRE, LAURIE DIANE (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:DIANE
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:DIANE
Other - Last Name:MCGUIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SPEECH PATHOLOGIST
Mailing Address - Street 1:1406 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:CALISTOGA
Mailing Address - State:CA
Mailing Address - Zip Code:94515-1610
Mailing Address - Country:US
Mailing Address - Phone:707-326-8841
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE MEDICAL GROUP 3975 OLD REDWOOD HWY.
Practice Address - Street 2:MOB 5 - OUTPATIENT REHAB
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-566-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP #5427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist