Provider Demographics
NPI:1003115767
Name:ACHIVIDA, LAURA NICOLE (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:NICOLE
Last Name:ACHIVIDA
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:NICOLE
Other - Last Name:WILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18700 W. LAKE HOUSTON PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3349
Mailing Address - Country:US
Mailing Address - Phone:713-338-9768
Mailing Address - Fax:
Practice Address - Street 1:18700 W. LAKE HOUSTON PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3349
Practice Address - Country:US
Practice Address - Phone:713-338-9768
Practice Address - Fax:713-366-4359
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist